Siguan points-based acupuncture treatment for migraine: A systematic review with meta-analysis of clinical efficacy and neurovascular regulatory effects

Siguan points, comprising bilateral Hegu (LI4) and Taichong (LR3), have shown good therapeutic potential in migraine management. We aimed to systematically evaluate the clinical efficacy and neurovascular regulatory mechanisms of Siguan points-based acupuncture treatment (SPBAT) for migraine. A comprehensive literature search was conducted across 15 databases through January 1st, 2025. Randomized controlled trials (RCTs) comparing SPBAT with conventional pharmacotherapy or sham acupuncture were included. Primary outcomes encompassed the clinical effective rate and the headache intensity measured by the visual analogue scale (VAS). Secondary outcomes included attack frequency, migraine days, doses of analgesics, adverse events (AEs), and other relevant measures. Dichotomous variables were reported as risk ratios (RR) or risk differences (RD), and continuous variables as mean differences (MD) or standardized mean differences (SMD); all estimates were presented with 95 % confidence intervals (CIs). Trial sequential analysis (TSA) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) were employed to assess evidence reliability and certainty. The neurovascular regulatory mechanisms of Siguan points for migraine were systematically reviewed. Analysis of 19 RCTs (1312 participants) demonstrated significant improvements with SPBAT in clinical effective rate (RR 1.22 [1.14, 1.31]), VAS for headache intensity (MD -1.11 [-1.50, -0.73]), attack frequency (SMD -0.81 [-1.49, -0.14]), and other outcomes. TSA confirmed the robustness of primary outcome findings. GRADE assessment indicated moderate to low evidence certainty across outcomes. No significant differences in AEs were observed between groups (RD -0.04 [-0.11, 0.04]). Mechanistic investigations revealed that Siguan points exerted therapeutic effects through integrated modulation of central pain processing networks and peripheral neurovascular pathways. SPBAT demonstrates significant efficacy in reducing migraine severity, duration, and frequency while maintaining a safety profile comparable to standard treatments. Its neurovascular regulatory effects and clinical benefits position SPBAT as a viable alternative for migraine management, though further high-quality research is warranted to strengthen the evidence base.