Abstract
BACKGROUND: Migraine is a prevalent and debilitating neurological disorder that results in significant disability and imposes a substantial socioeconomic burden. Auricular Acupuncture (AA) has emerged as a potential therapeutic intervention for alleviating migraine symptoms. Although AA is extensively utilized clinically to treat migraines, a reanalysis investigating its benefits and risks, whose studies were conducted exclusively in China, indicated that notable enhancements in four outcomes relative to controls were achieved by AA. METHODS: We conducted a systematic review and meta-analysis of Randomized Controlled Trials (RCTs) to evaluate the efficacy and safety of AA for migraine. Eight databases were searched from inception to April 18, 2025. Sensitivity and subgroup analyses were performed to evaluate the robustness of the findings and to identify potential sources of heterogeneity. All results were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Data analyses were conducted using Review Manager 5.4. RESULTS: Specifically, the visual analog scale (VAS) showed a mean difference (MD) of -0.65 (95% Confidence Intervals (CI): -0.86, -0.43; p<0.001) in ten RCTs involving 766 participants were included. Additionally, migraine attack frequency demonstrated an MD of -0.49 (95% CI: -0.59, -0.40; p<0.001) and attack duration had an MD of -0.58 (95% CI: -0.64, -0.52; p<0.001). The clinical effectiveness rate (CER) was reflected in a relative risk of 1.17 (95% CI: 1.10, 1.25; p<0.001). CONCLUSION: Research evidence indicates that AA offers both efficacy and safety in the treatment of migraines. However, inferences resulting from this investigation face constraints arising from the methodological robustness of trials incorporated herein. To better define the role of AA in clinical guidelines, additional high-quality RCTs with expanded scope of population, standardized protocols and extended follow-up periods are required. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251028201.