Resting-state fMRI correlates of acupuncture in migraine: a coordinate-based meta-analysis

Background: Although acupuncture has shown prophylactic benefits for migraine, its neural mechanisms remain elusive. This study systematically synthesized whole-brain resting-state functional magnetic resonance imaging (fMRI) evidence to characterize changes in spontaneous brain activity after acupuncture treatment in patients with migraine. Methods: We systematically searched eight databases for resting-state fMRI studies that used whole-brain analyses to compare patients with migraine before and after acupuncture. Only studies reporting amplitude of low-frequency fluctuation (ALFF) or regional homogeneity (ReHo) were eligible for quantitative meta-analysis. Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) was used to conduct the coordinate-based meta-analysis. Meta-regression analyses explored associations between regional brain changes and clinical outcomes. Results: Thirteen studies comprising 19 datasets and 312 patients were included. At the prespecified uncorrected SDM-PSI threshold, acupuncture treatment was associated with increased ALFF in the right middle frontal gyrus and increased ReHo in the left angular gyrus and right superior temporal gyrus, together with decreased ReHo in the right precuneus. Exploratory meta-regression suggested that greater pain reduction was associated with smaller ReHo increases in the right superior temporal gyrus, whereas greater reduction in attack frequency was associated with greater ReHo increases in the left angular gyrus. Conclusions: Acupuncture may be associated with altered spontaneous neural activity in regions of the executive control network, default mode network, and multisensory processing regions. These findings provide preliminary neuroimaging evidence for the central correlates of acupuncture in migraine. However, they should be interpreted cautiously given the limited evidence base, methodological heterogeneity, and exploratory nature of the meta-regression analyses. The PROSPERO Registration: The review was registered in PROSPERO (CRD420251145641).

Migraine; Acupuncture; Resting-state fMRI; Meta-analysis; SDM-PSI

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