Acupuncture for migraine: a literature review of neuroimaging studies

Abstract

Background: Acupuncture is effective for migraine treatment with minimal side effects. Neuroimaging techniques have been extensively used to explore the central mechanisms of acupuncture for migraine. This review aims to summarize neuroimaging study of acupuncture for migraine, providing a valuable reference and foundation for future clinical and mechanistic research.

Methods: From database inception to November 19, 2024, we conducted a comprehensive search of four English-language and four Chinese-language databases. All published clinical controlled trials utilizing neuroimaging methods were included after rigorous screening. This review summarizes the immediate and preventive effects of acupuncture in migraine treatment, as well as the possible neural mechanisms underlying its efficacy in alleviating pain and non-pain symptoms.

Results: A total of 833 papers were identified, and 40 met the inclusion criteria after screening. Among them, 8 studies focused on the immediate effects of acupuncture, while 32 investigated its preventive effects. General, methodological, and neuroimaging data were extracted and summarized. These studies utilized various neuroimaging techniques, including functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), transcranial Doppler sonography (TCD), and magnetic resonance spectroscopy (MRS). The immediate effects of acupuncture treatment for migraines primarily involve brain regions such as the middle frontal gyrus (MFG), precuneus, and postcentral gyrus, most of which belong to the default mode network (DMN), central executive network (CEN), and salience network (SN). In terms of preventive effects, the key regions involved are the precuneus, anterior cingulate cortex (ACC), MFG, most of which involved in the DMN, SN, CEN, and descending pain modulatory system (DPMS).

Conclusion: This systematic review reveals that the brain regions involved in acupuncture treatment for migraine headache include the DMN, SN, CEN, and DPMS, which are related to pain sensation, emotion and modulation. Future research could prioritize meticulously designed, high-quality, multimodal neuroimaging studies to further elucidate the neuroimaging evidence for acupuncture in migraine treatments from different aspects.

Keywords: acupuncture; functional magnetic resonance imaging; literature review; migraine; neuroimaging mechanisms.

Figure 1

The flow diagram of literature screening.

Figure 2

The research design of the included studies. (a) The proportion of various types of migraine. (b) The proportion of the number of acupuncture—treatment sessions. (c) The proportion of the variables for clinical efficacy assessment of migraine. (d) The proportion of different trial design types. (e) The proportion of neuroimaging techniques employed. (f) The proportion of the data—analysis modalities for neuroimaging. VAS, Visual Analogue Scale; SAS, Self-Rating Anxiety Scale; SDS, Self-Rating Depression Scale; MSQ, Migraine-Specific Quality of Life Questionnaire; HIT-6, Headache Impact Test-6; PSQI, Pittsburgh Sleep Quality Index; MIDAS, Migraine Disability Assessment Questionnaire; BDI, Beck Depression Inventory; BAI, Beck Anxiety Inventory; RCTs, randomized controlled trials; fMRI, functional magnetic resonance imaging; DTI, diffusion tensor imaging; FDG-PET/CT, Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography; MRS, magnetic resonance spectroscopy; TCD, transcranial Doppler; ALFF, amplitude of low-frequency fluctuations; FC, functional connectivity; ReHo, regional homogeneity; ICA, independent component analysis; SBA, seed-based analysis; DC, dynamic causal modeling; GT-LS-BFNA, graph theory-based large-scale brain functional network analysis; VMHC, voxel-mirrored homotopic connectivity; dFNC, dynamic functional network connectivity; rsFC, resting-state functional connectivity; SCA, spectral clustering analysis; DEC, dynamic effective connectivity.

Figure 3

The primary alterations in brain regions and networks induced by immediate acupuncture. PCUN, precuneus; MFG, middle frontal gyrus; PoG, postcentral gyrus; PHG, parahippocampal gyrus; MCC, middle cingulate cortex; INS, insula; SFG, superior frontal gyrus; PreCG, precentral gyrus; ACC, anterior cingulate cortex; SMG; supramarginal gyrus.

Figure 4

The primary alterations in brain regions and networks induced by preventive acupuncture. ACC, anterior cingulate cortex; PCUN, precuneus; MFG, middle frontal gyrus; IPL, inferior parietal lobule; STG, superior temporal gyrus; THA, thalamus; INS, insula; SFG, superior frontal gyrus; MTG, middle temporal gyrus; PCG, posterior cingulate gyrus.