These findings were reported in a randomized clinical trial published in
JAMA Network Open by Xinyu Zhang from the Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China, and colleagues. The study is among the first to integrate machine learning–based connectome analysis with clinical evaluation of acupuncture in migraine without aura (MWOA).
Migraine without aura is a common neurological disorder that significantly affects quality of life. Although acupuncture is widely used for migraine management, its mechanisms and predictors of response remain unclear. This study assessed the effectiveness of acupuncture versus sham treatment and examined whether baseline brain connectivity could predict treatment response.
The single-blinded randomized trial, conducted in Beijing between June 2021 and June 2023, included 120 adults aged 18 to 65 years with migraine without aura. Participants were randomly assigned to real or sham acupuncture and underwent baseline clinical assessments and resting-state fMRI.
Both groups received 12 sessions over four weeks. Real acupuncture used traditional acupoints with deqi sensation, while sham acupuncture used nonacupoints without deqi. The primary outcome was change in monthly migraine days, with secondary measures including headache frequency, medication use, pain severity, disability, and migraine-related quality of life.
The trial revealed the following findings:
- Real acupuncture led to a significantly greater reduction in monthly migraine days compared with sham acupuncture.
- Participants receiving real acupuncture experienced a meaningful decrease in overall headache frequency.
- Use of acute migraine medications was reduced among patients treated with real acupuncture.
- Pain intensity scores measured using the visual analog scale were significantly lower in the real acupuncture group.
- Headache-related disability, assessed using the Headache Impact Test-6, showed notable improvement with real acupuncture.
- Quality-of-life scores improved across multiple domains among participants receiving real acupuncture.
- Connectome-based predictive modeling using baseline fMRI data demonstrated that whole-brain functional connectivity patterns could predict individual responses to acupuncture.
- Reduced connectivity between the default mode network and subcortical–cerebellar regions was associated with greater pain relief.
- Increased connectivity between subcortical–cerebellar and motor networks predicted greater reductions in migraine-related disability.
The authors noted several limitations, including the exclusion of other migraine subtypes, which may limit generalizability, and the absence of posttreatment MRI scans to capture dynamic brain changes over time. Nevertheless, the findings provide compelling evidence that acupuncture is effective for MWOA and that brain connectivity signatures may serve as objective biomarkers to guide personalized treatment strategies.
Overall, the study highlights the potential of combining neuroimaging and machine learning approaches with traditional therapies to optimize migraine management and tailor treatment to individual patients.
Reference:
Zhang X, Chen Q, Liu Y, et al. Acupuncture for Migraine Without Aura and Connection-Based Efficacy Prediction: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(1):e2555454. doi:10.1001/jamanetworkopen.2025.55454
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