Acupuncture for migraine prophylaxis: benefit limited to a narrow thera-peutic indication – studies are lacking for the majority of indications

On behalf of the Federal Joint Committee (G-BA), the Institute for Quality and Efficiency in Health Care (IQWiG) assessed the benefit of manual acupuncture for migraine prophylaxis in adults, compared with migraine prevention medication. A second comparison investigated whether, for people who cannot use prophylaxis medication, acupuncture is more effective than no prophylaxis.

Publication date original (German-language) report: 28 April 2026; English translation: August 2026

Currently, people who suffer from frequent migraine attacks receive various prophylactic medications, e.g. propranolol and metoprolol (beta-blockers), flunarizine, topiramate, amitriptyline or a botulinum toxin. If this prophylaxis does not provide sufficient help, antibodies that target the calcitonin gene-related peptide (CGRP)have also been available as a second-line treatment since 2019. Prophylaxis can be supported by non-drug methods, such as behavioural therapy or psychological interventions. Acupuncture has long been the subject of discussion as an alternative form of prophylaxis: As many as 20 years ago, Germany’s statutory health insurance funds commissioned a large-scale study.

IQWiG's final report, which has now been published, shows that there are no relevant studies for the majority of therapeutic indications of manual acupuncture for migraine prevention. This applies both to patients for whom drug therapy is not (or is no longer) an option, and to those for whom drug therapy with conventional drugs does not provide adequate symptom control and for whom second-line treatment with CGRP-targeted therapies is being conducted or is under consideration. There is therefore no proof of a benefit of manual acupuncture using needles in these two therapeutic indications.

Informative studies only exist for the comparison of manual acupuncture with individual conventional drugs – specifically the older drugs flunarizine and topiramate. However, as for various reasons the use of topiramate and flunarizine is limited in clinical practice, these studies only allowed an advantage of acupuncture to be derived for a narrow therapeutic indication. There are no studies comparing acupuncture with other conventional, approved medicines such as beta-blockers, amitriptyline or onabotulinum toxin A.

In its preliminary report, IQWiG had already pointed out the limited transferability of the assessment results to the German health care context, due to the lack of comparative studies with the beta-blockers commonly used in Germany and also with the newer CGPR antibodies. Such studies were also not referred to in the commenting procedure. “Acupuncture research has fallen behind to some extent,” says Stefan Sauerland, Head of IQWiG’s Non-Drug Interventions Department, interpreting the evidence base. “There have been no studies to investigate whether acupuncture can also keep up with other and more modern options of migraine prevention medication.”

The process of report production

On 16 January 2025, the G-BA commissioned IQWiG to conduct an assessment of acupuncture for migraine prophylaxis. The preliminary assessment was published on the IQWiG website on 26 November 2025 and interested parties were invited to submit comments (written hearing). The final report, which has now been published, includes amendments resulting from the hearing.