The Quality of Acupuncture Recommendations for Migraine in Global Headache Guidelines: A Systematic Review Using the AGREE II and AGREE-REX Instruments

Abstract

Background and objective: This study aims to identify the quality of acupuncture recommendations for migraine in global headache guidelines. Methods: Global migraine guidelines published before June 2022 were searched and screened. The AGREE II (Appraisal of Guidelines for Research & Evaluation II) and AGREE-REX (The Appraisal of Guidelines Research & Evaluation Recommendation Excellence) were used to evaluate the reporting quality, methodology quality, and acupuncture recommendations in the included guidelines. Results: Of the 16 guidelines included, 14 recommended acupuncture treatment for migraine (8 were rated as B by AGREE II, and 6 were rated as C), while 2 recommended against acupuncture treatment (rated as C). One guideline described detailed manipulations (1/14), two described treatment sessions and courses (2/14), and 11 only indicated that acupuncture was effective but without a specific treatment plan mentioned (11/14). The results of the AGREE-REX showed that all 16 guidelines scored relatively high only in the “Evidence” item (mean score: 57.29%), whereas the scores of the other 8 items were low. Conclusions: Among the current headache guidelines around the world, the number of guidelines recommending acupuncture for migraine treatment is small, the content of recommendations involving acupuncture treatment is limited, and the recommendations for detailed acupuncture treatment programs are insufficient. Within the included guidelines recommending acupuncture for migraine treatment, the report quality, methodology quality, and quality of acupuncture recommendations are low; therefore, it is difficult to meet clinical needs.