Compiled by Joseph Brady MSTCM, L.Ac., Dipl. OM

Contact: taichiproj@earthlink.net | joe.brady@faculty.ccmu.edu

1529 York Street, Denver, CO 80206

Acknowledgements

Special thanks to Cheryl Wheeler and Jacqui Shumway for their invaluable assistance in verifying and formatting references. Each review is a snapshot of the best available evidence at the time of publication and will be updated regularly to reflect new research.

Author’s Note on AI Use

Artificial intelligence was used to assist with formatting, reference management, and language refinement in the preparation of this manuscript. All content, including interpretation of data and conclusions, was reviewed and verified by the author to ensure accuracy and scholarly integrity.

Chinese Medicine for Headache: Evidence Review

Headache disorders—particularly migraine and tension-type headache (TTH)—are among the most prevalent and disabling neurological conditions worldwide. Pharmacological prophylaxis and acute treatments are effective for many, but limitations in efficacy and tolerability drive interest in complementary approaches. Traditional Chinese Medicine (TCM) offers multiple modalities, most notably acupuncture, herbal formulations, Tai Chi, Qigong, and dietary therapy. This review synthesizes high-quality evidence, prioritizing systematic reviews, meta-analyses, and large RCTs, and ranks evidence strength using the GRADE framework.

Acupuncture

Acupuncture is the most extensively studied TCM modality for headache. The 2012 individual patient data meta-analysis by Vickers et al. (29 RCTs; >17,000 participants) found acupuncture effective for chronic pain, including migraine and TTH, with effects exceeding sham/placebo and comparable to conventional care—rated high-quality evidence (GRADE: High).

A Cochrane review for migraine prevention (Linde et al., 2016; 22 trials) concluded acupuncture reduces headache frequency and is as effective as prophylactic drug therapy with fewer side effects. For TTH, a Cochrane review (Linde et al., 2016; 12 RCTs) found moderate benefits over sham/usual care (GRADE: Moderate).

Recent analyses refine these findings. Wang et al. (2023) reported acupuncture for acute migraine may be superior to sham and comparable to medication, though with low–very low certainty. Liu et al. (2024) found acupuncture-related therapies superior to other comparators in network meta-analysis, while Yang et al. (2024) identified optimal dosing at 16 sessions, 3×/week for 1.5–2 months. Shi et al. (2023) demonstrated effects persisting at least 3 months post-treatment. Li et al. (2023) showed superior improvement in migraine-related anxiety and depression compared with Western medicine or sham. Across studies, adverse events are rare and minor.

Chinese Herbal Medicine

Evidence for herbal therapies is promising but of lower certainty. A systematic review and meta-analysis of Chuanxiong formulae (Wang, 2018) reported significant reductions in migraine frequency, duration, and severity versus placebo or conventional therapy, with low adverse event rates. A 2020 meta-analysis (Zhang et al., 2020) found oral CHM comparable to flunarizine for episodic migraine prevention. High-frequency herbs include Chuan Xiong (Ligusticum chuanxiong), Bai Zhi (Angelica dahurica), and Tian Ma (Gastrodia elata). However, heterogeneity in formulas and study design limits generalizability (GRADE: Low–Moderate).

Tai Chi and Qigong

Tai Chi has emerging evidence for headache prophylaxis. A Hong Kong RCT (Xie et al., 2022; n≈80) found 12-week Yang-style Tai Chi reduced migraine frequency by ~3 attacks/month compared to control, with added cardiovascular benefits. Abbott et al. (2007) reported improved quality of life and headache impact in TTH with a 15-week program. GRADE is Low–Moderate due to small sample sizes and limited replication. No high-quality RCTs specifically assess Qigong for headache, but mechanistic overlaps with Tai Chi suggest potential benefit.

Dietary Therapy and Integrated Approaches

Auricular acupuncture combined with Chinese dietary therapy achieved 94% improvement rates in a large clinical series (Ling, unpublished scale; GRADE: Very Low due to design). Case reports and observational data suggest diet tailored to TCM pattern diagnosis can complement acupuncture and herbs.

Integrated protocols combining acupuncture, herbal medicine, and lifestyle/Tai Chi have been reported in both research and clinical practice, sometimes showing superior outcomes to single modalities. However, these are rarely tested in rigorous multi-arm RCTs.

Mechanisms

Proposed mechanisms for TCM headache interventions include modulation of neurotransmitters and neuropeptides, reduction of neuroinflammation, vascular regulation, central pain pathway modulation, and improved autonomic balance. Tai Chi and Qigong also reduce blood pressure, increase nitric oxide, and decrease endothelin-1, potentially relevant to migraine pathophysiology.

Conclusion

Acupuncture has the strongest and highest-quality evidence among TCM modalities for migraine and TTH, with efficacy comparable to conventional prophylaxis and fewer adverse effects. CHM—particularly Chuanxiong-based formulas—shows promise for migraine prevention but needs more high-quality, standardized trials. Tai Chi is safe and potentially effective, especially for migraine, but evidence is limited. Qigong and dietary therapy remain under-researched. For patients seeking integrative approaches, TCM offers safe adjunctive options, but larger, well-designed RCTs are needed to confirm efficacy and optimize protocols.

Key References (Ordered by Evidence Strength)

High-quality systematic reviews and meta-analyses (GRADE: High to Moderate)

Vickers, A. J., Cronin, A. M., Maschino, A. C., et al. (2012). Acupuncture for chronic pain: Individual patient data meta-analysis. Archives of Internal Medicine, 172(19), 1444–1453. https://doi.org/10.1001/archinternmed.2012.3654

Linde, K., Allais, G., Brinkhaus, B., Manheimer, E., Vickers, A., & White, A. R. (2016). Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews, 6, CD001218. https://doi.org/10.1002/14651858.CD001218.pub3

Wang, Y., Du, R., Cui, H., et al. (2023). Acupuncture for acute migraine attacks in adults: A systematic review and meta-analysis. BMJ Evidence-Based Medicine, 28(4), 228–240. https://doi.org/10.1136/bmjebm-2022-112135

Liu, Y., Wang, Y., Mi, C., Wang, Z., Han, Y., Qi, X., & Ding, X. (2024). Efficacy of acupuncture-related therapy for migraine: A systematic review and network meta-analysis. Journal of Pain Research, 17, 1107–1132. https://doi.org/10.2147/JPR.S452971

Shi, H., Miao, R., Gao, S., et al. (2023). The durable effect of acupuncture for episodic migraine: A systematic review and meta-analysis. Frontiers in Neuroscience, 17, 1211438. https://doi.org/10.3389/fnins.2023.1211438

Song, Y., Li, T., Ma, C., Liu, H., Liang, F., & Yang, Y. (2022). Comparative efficacy of acupuncture-related therapy for migraine: A systematic review and network meta-analysis. Frontiers in Neurology, 13, 1010410. https://doi.org/10.3389/fneur.2022.1010410

Song, Z. W., Liu, Y. P., Cui, S., et al. (2023). Effectiveness of acupuncture for prophylactic treatment of migraine: A systematic review and Bayesian network meta-analysis. Advanced Biology, 7(10), e2300134. https://doi.org/10.1002/adbi.202300134

Ou, M. Q., Fan, W. H., Sun, F. R., et al. (2020). A systematic review and meta-analysis of the therapeutic effect of acupuncture on migraine. Frontiers in Neurology, 11, 596. https://doi.org/10.3389/fneur.2020.00596

Moderate- to low-quality systematic reviews and RCTs (GRADE: Low–Moderate)

Li, Z., Feng, J., Yin, S., Chen, X., Yang, Q., Gao, X., Che, D., Zhou, L., Yan, H., Zhong, Y., & Zhu, F. (2023). Effects of acupuncture on mental health of migraine patients: A systematic review and meta-analysis. BMC Complementary Medicine and Therapies, 23(1), 278. https://doi.org/10.1186/s12906-023-04103-8

Yang, C., Wu, M., Luo, Q., et al. (2024). Acupuncture for migraine: A systematic review and meta-regression of randomized controlled trials. Complementary Therapies in Medicine, 86, 103076. https://doi.org/10.1016/j.ctim.2024.103076

Naguit, N., Laeeq, S., Jakkoju, R., et al. (2022). Is acupuncture safe and effective treatment for migraine? A systematic review of randomized controlled trials. Cureus, 14(1), e20888. https://doi.org/10.7759/cureus.20888

Abbott, R. B., Hui, K. K. S., Hays, R. D., et al. (2007). A randomized controlled trial of tai chi for tension headaches. Evidence-Based Complementary and Alternative Medicine, 4(1), 107–113. https://doi.org/10.1093/ecam/nel050

Xie, Y. J., Hui, S. S. C., & Gao, Y. (2022). Efficacy and feasibility of a 12-week Tai Chi training for the prophylaxis of episodic migraine in Hong Kong Chinese women: A randomized controlled trial. Frontiers in Public Health, 10, 1000594. https://doi.org/10.3389/fpubh.2022.1000594

Wang, Y. (2018). Chuanxiong formulae for migraine: A systematic review and meta-analysis of high-quality randomized controlled trials. Frontiers in Pharmacology, 9, 589. https://doi.org/10.3389/fphar.2018.00589

Zhang, C. S., Guo, X., & Zhang, A. L. (2020). Oral Chinese herbal medicine as prophylactic treatment for episodic migraine in adults: A systematic review and meta‐analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2020, 5181587. https://doi.org/10.1155/2020/5181587

Lower-quality or preliminary evidence (GRADE: Low to Very Low)

Ling, H. W. (n.d.). Auricular acupuncture and Chinese dietary therapy in the treatment of patients with chronic headache. Journal of Integrative Medicine, 2(2), 1–8. https://doi.org/10.22259/2638-504x.0202001