OBJECTIVE: A systematic review (SR) with meta-analysis (MA) was conducted to investigate acupuncture's efficacy in treating migraine and its impact on quality of life. METHODS: PubMed, Embase, Cochrane Library, Chinese Biomedical Databases, China National Knowledge Infrastructure, VIP, and Wanfang were searched for randomized controlled trials (RCTs) from database inception to May 31, 2024. Statistical analyses were performed with Review Manager 5.4.1. RESULTS: We included 23 RCTs comprising 2295 patients. Compared with sham acupuncture, acupuncture reduced migraine duration (MD -4.36 h; 95% CI -8.07 to -0.64), the number of mean migraine attacks (MD -0.82; 95% CI -1.57 to -0.08), days with migraine per 4 weeks (MD -1.38; 95% CI -2.16 to -0.60), improved MSQ restrictive subscale (MD 13.73; 95% CI 5.60 to 21.87) and MSQ emotional function (MD 9.93; 95% CI 2.64 to 17.22). Compared with pharmacological treatment, acupuncture improved MSQ restrictive subscale (MD 5.69; 95% CI 2.15 to 9.23) and MSQ emotional function (MD 7.14; 95% CI 1.62 to 12.66). Compared with waiting lists, acupuncture reduced the number of mean migraine attacks (MD -0.80; 95% CI -1.12 to -0.48), days with migraine per 4 weeks (MD -2.10; 95% CI -2.74 to -1.46), and improved MSQ restrictive subscale (MD 9.40; 95% CI 4.82 to 13.98) and MSQ emotional function (MD 9.00; 95% CI 4.52 to 13.48). CONCLUSIONS: Acupuncture was significantly associated with reduced migraine duration, number of migraine attacks, number of migraine days, and improved quality of life. However, due to language restrictions and potential bias, further rigorous trials are needed to identify its efficacy and relevant exploratory trials are also warranted.

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