Efficacy and safety of Chinese botanical drug decoctions for migraine: a Bayesian network meta-analysis

Background Migraine is a common neurological disorder that substantially affects patients’ quality of life. Chinese botanical drug decoctions are used in migraine management; however, the comparative efficacy and safety of different decoctions remain unclear. Therefore, this study aimed to compare multiple Chinese botanical drug decoctions for migraine using a Bayesian network meta-analysis. Methods Seven electronic databases (PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP) were systematically searched from inception to 20 October 2025. Randomized controlled trials evaluating Chinese botanical drug decoctions for migraine were included. Risk of bias was assessed using the ROB 2.0 tool. A Bayesian network meta-analysis was conducted using R software with the gemtc package. Four Markov chains were run simultaneously, with 50,000 iterations and a burn-in period of 20,000 iterations to ensure model convergence. Treatment ranking probabilities were estimated using the surface under the cumulative ranking curve (SUCRA). Results A total of 57 randomized controlled trials involving 6,005 patients were included. Network meta-analysis suggested that Sanpian Decoction (SPT) was associated with greater reductions in visual Analog Scale (VAS) scores, while Xuefu Zhuyu Decoction (XFZYT) ranked highest for reducing headache frequency and duration. Tongqiao Huoxue Decoction (TQHXT) had the highest probability of being among the most effective interventions based on SUCRA rankings. Conclusion Chinese botanical drug decoctions may be associated with improvements in migraine-related outcomes. Among the evaluated interventions, SPT may be associated with greater reductions in pain intensity, XFZYT may be associated with reductions in attack frequency and duration, and TQHXT had the highest SUCRA-based ranking for overall efficacy. However, these findings should be interpreted with caution due to variability in study quality and the indirect nature of comparisons. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251176748 .