The effectiveness and safety of different electromagnetic stimulation therapies in treating migraine: a systematic review and network meta-analysis

Current preventive strategies for migraine are hindered by limited response rates, often accompanied by varying degrees of adverse reactions and low long-term treatment adherence. Although electromagnetic stimulation has shown potential efficacy in migraine prevention, the evidence supporting its effectiveness remains inconsistent. Therefore, this study utilizes a network meta-analysis (NMA) to compare the effectiveness and acceptability of various electromagnetic stimulation strategies for migraine prevention. We conducted a comprehensive search across four English databases—PubMed, Embase, the Cochrane Library, and Web of Science—and four Chinese databases—China National Knowledge Infrastructure, VIP Database, Wanfang Database, and SinoMed—to identify randomized controlled trials assessing the efficacy of electromagnetic stimulation in the treatment of migraines. The search was conducted with a cutoff date of September 14, 2025. The quality of the included randomized controlled trials was evaluated using the Cochrane Risk of Bias tool (ROB 2.0). Additionally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was employed to assess the risk of bias and the overall quality of evidence. A network meta-analysis was performed utilizing STATA software. This study included 64 trials involving 5372 participants. The results demonstrated that Theta-burst Transcranial Magnetic Stimulation (TBS) showed a significant advantage in clinical response rate compared to the control group (RR = 1.62, 95% CI 1.28 to 2.04). Deep transcranial magnetic stimulation (dTMS) exhibited the most effective reduction in pain intensity (MD = − 3.48; 95% CI − 6.77 to − 0.20), while electroacupuncture (EA) resulted in the most significant reduction in migraine-related disability (MD = − 4.74, 95% CI − 9.08 to − 0.40). In terms of safety, transcutaneous vagus nerve stimulation (taVNS) (RR = 0.06, 95% CI 0.00 to 0.96) and electrical stimulation (ES) (RR = 0.33, 95% CI 0.11 to 0.97) demonstrated favorable safety profiles. Additionally, the study conducted sensitivity analyses, demonstrating that the findings exhibit good robustness. Preliminary evidence suggests that incorporating electromagnetic stimulation therapy as an adjunct intervention may enhance recovery and improve safety for migraine patients. Specifically, tDCS shows relatively superior potential efficacy in improving clinical response rates; dTMS not only demonstrates relatively superior potential efficacy in reducing pain intensity but also exhibits greater potential benefits in alleviating the overall impact of headaches on daily life, emotional well-being, and social functioning; TENS holds relatively superior potential efficacy in reducing migraine-related functional impairment. Regarding safety, taVNS and TENS demonstrate favorable safety profiles in migraine treatment. However, caution is warranted when interpreting these findings due to the low quality of the evidence. Higher-quality, larger-scale trials are still needed to validate these results. Trial registration PROSPERO, CRD420251146776