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Peer-reviewedCC BY 4.0Frontiers in Neurology

Changes in plasma CGRP levels and clinical outcomes following acupuncture in episodic migraine: a prospective pilot study (the AcuCGRP study)

  • Valentina Favoni1
  • Lorenzo Giusti2
  • Fiorina Bartiromo1
  • Alessandra Poini3
  • Calogero Calabrò4
  • Elena Merli1
  • Barbara Polischi1
  • Flavia Baccari1
  • Corrado Zenesini1
  • Davide Mascarella1
  • Giulia Pierangeli1,5
  • Carlo Maria Giovanardi3
1 more authors
  • Sabina Cevoli1
5 affiliations
  1. 1IRCCS Istituto delle Scienze Neurologiche di Bologna
  2. 2Neurologia ASL Teramo
  3. 3Association of Medical Acupuncturists of Bologna, Research and Healthcare Institute
  4. 4Azienda USL di Bologna
  5. 5Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna
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Abstract

Background: Manual acupuncture is an established non-pharmacological treatment for migraine, with efficacy comparable to conventional prophylactic therapies. Calcitonin gene-related peptide (CGRP) plays a central role in migraine pathophysiology and has been proposed as a biomarker for treatment response. This study aimed to investigate changes in plasma CGRP levels in patients with episodic migraine undergoing a course of manual acupuncture.

Methods: Fifty-two patients with episodic migraine received 10 sessions of standardized manual acupuncture. Clinical assessments and plasma samples were collected at baseline and one week after treatment completion. The primary outcome was the change in plasma CGRP levels. Secondary outcomes included changes in migraine frequency, pain intensity, acute medication intake, and HIT-6.

Results: No statistically significant change in plasma CGRP levels was observed (baseline: 60.9 pg/ml; after treatment: 62.4 pg/ml; p = 0.841). Significant clinical improvements were observed, in migraine frequency (median decrease of 1.5 days/month, p < 0.001), pain intensity (1-point decrease on a 10-point scale, p < 0.001), acute medication use (2 units/month, p < 0.001), and HIT-6 score (−6 points; p < 0.001).

Conclusions: This is the first study to investigate changes in plasma CGRP levels following acupuncture in patients with episodic migraine. While CGRP levels remained unchanged, patients experienced reductions in headache frequency, intensity, medication use, and disability. Although these improvements may be attributable, at least in part, to acupuncture, the single-arm design precludes causal inference. Peripheral plasma CGRP may not be a straightforward biomarker of clinical changes in this setting. Controlled studies are warranted.

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Cite

BibTeXRIS
BibTeX
@article{favoni2026changes,
  title = {{Changes in plasma CGRP levels and clinical outcomes following acupuncture in episodic migraine: a prospective pilot study (the AcuCGRP study)}},
  author = {Valentina Favoni and Lorenzo Giusti and Fiorina Bartiromo and Alessandra Poini and Calogero Calabrò and Elena Merli and Barbara Polischi and Flavia Baccari and Corrado Zenesini and Davide Mascarella and Giulia Pierangeli and Carlo Maria Giovanardi and Sabina Cevoli},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1946490},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1946490/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Changes in plasma CGRP levels and clinical outcomes following acupuncture in episodic migraine: a prospective pilot study (the AcuCGRP study)
AU  - Valentina Favoni
AU  - Lorenzo Giusti
AU  - Fiorina Bartiromo
AU  - Alessandra Poini
AU  - Calogero Calabrò
AU  - Elena Merli
AU  - Barbara Polischi
AU  - Flavia Baccari
AU  - Corrado Zenesini
AU  - Davide Mascarella
AU  - Giulia Pierangeli
AU  - Carlo Maria Giovanardi
AU  - Sabina Cevoli
PY  - 2026
DA  - 2026/10/16
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1946490
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1946490/full
AB  - Background: Manual acupuncture is an established non-pharmacological treatment for migraine, with efficacy comparable to conventional prophylactic therapies. Calcitonin gene-related peptide (CGRP) plays a central role in migraine pathophysiology and has been proposed as a biomarker for treatment response. This study aimed to investigate changes in plasma CGRP levels in patients with episodic migraine undergoing a course of manual acupuncture.  Methods: Fifty-two patients with episodic migraine received 10 sessions of standardized manual acupuncture. Clinical assessments and plasma samples were collected at baseline and one week after treatment completion. The primary outcome was the change in plasma CGRP levels. Secondary outcomes included changes in migraine frequency, pain intensity, acute medication intake, and HIT-6.  Results: No statistically significant change in plasma CGRP levels was observed (baseline: 60.9 pg/ml; after treatment: 62.4 pg/ml; p = 0.841). Significant clinical improvements were observed, in migraine frequency (median decrease of 1.5 days/month, p < 0.001), pain intensity (1-point decrease on a 10-point scale, p < 0.001), acute medication use (2 units/month, p < 0.001), and HIT-6 score (−6 points; p < 0.001).  Conclusions: This is the first study to investigate changes in plasma CGRP levels following acupuncture in patients with episodic migraine. While CGRP levels remained unchanged, patients experienced reductions in headache frequency, intensity, medication use, and disability. Although these improvements may be attributable, at least in part, to acupuncture, the single-arm design precludes causal inference. Peripheral plasma CGRP may not be a straightforward biomarker of clinical changes in this setting. Controlled studies are warranted.
SN  - 1664-2295
ER  -