Acupuncture for Migraine Prevention and Tension-Type Headaches

Summary

Acupuncture has been studied mainly as a way to prevent headaches, not to treat one that has started. Cochrane reviews found a small benefit over sham acupuncture for frequent migraine and tension-type headache, and a larger one over no preventive treatment. NICE says acupuncture may be considered in specific situations. Evidence label: promising but limited. General background is on what is acupuncture.

Migraine prevention

A 2016 Cochrane review pooled 22 trials with 4,985 people with episodic migraine. [1]

• Against no acupuncture. Headache frequency fell by a moderate amount, and headache frequency was at least halved in 41 percent of those given acupuncture versus 17 percent of controls (moderate-quality evidence). These trials could not be blinded.
• Against sham. A small but statistically significant reduction: frequency at least halved in 50 percent of the acupuncture group and 41 percent of sham (moderate-quality evidence).
• Against preventive drugs. Acupuncture reduced frequency more than drugs right after treatment, but the difference was not significant at follow-up. People on acupuncture were less likely to drop out or report side effects than those on drugs.

NCCIH adds that a 2020 review of nine studies comparing acupuncture with drugs found acupuncture slightly more effective, and that benefit may be partly due to expectation and placebo responses. [2][3]

Tension-type headache

A 2016 Cochrane review of 12 trials (2,349 people) found acupuncture effective for frequent episodic or chronic tension-type headache, with further trials needed. [4]

• Against routine care or acute-only treatment, two large unblinded trials found many more people with at least a 50 percent drop in headache frequency (moderate-quality evidence).
• Against sham, 51 percent versus 43 percent reached that drop (moderate-quality evidence). Dropouts for side effects were low.
• Against physiotherapy, massage or exercise, no trial showed acupuncture to be better (lower quality evidence).

What guidelines say

NICE (headaches in over 12s, updated June 2025) says to consider up to 10 sessions over 5 to 8 weeks of acupuncture for preventing chronic tension-type headache. For migraine prevention, if propranolol, topiramate and amitriptyline have not worked or are unsuitable, consider a similar course, according to the person's preference, other conditions and risk of adverse events. [5] The NHS says it may offer acupuncture for migraine-type headaches. [6]

Not covered

We found no source we could read showing acupuncture stops a migraine attack once it has started, so we do not make that claim. Cluster headache, medication-overuse headache and headaches in children were outside the sources we read.

Safety and when to get urgent care

Acupuncture is generally considered safe when done by an experienced practitioner with sterile needles, and improper treatment can cause serious side effects. [3] See side effects and precautions. NICE tells clinicians to consider further investigation or referral for headache with fever, a sudden headache reaching maximum intensity within 5 minutes, new neurological symptoms, confusion, recent head injury, or a substantial change in the pattern of headaches. [5] Get medical assessment for these before considering acupuncture. In the U.S., call 911 in an emergency.