A traumatic brain injury (TBI) is damage to the brain from an outside force, such as a fall, a road collision or a blast. The Cochrane review of acupuncture for it describes a range from life-threatening injury to lasting problems with thinking, movement, speech, mood and behaviour that need rehabilitation. The research on acupuncture splits by severity. Trials in severe injury, almost all from China, measure arousal from coma on the Glasgow Coma Scale (GCS), a bedside score of eye opening, speech and movement on which a higher score means a more responsive patient, and recovery on the Glasgow Outcome Scale (GOS). Trials in mild injury, or concussion, measure the symptoms that persist afterwards: headache, poor sleep and the cluster called post-concussion syndrome.
The Cochrane review
Wong, Cheuk, Lee and Chu, from the University of Hong Kong, published Acupuncture for acute management and rehabilitation of traumatic brain injury in the Cochrane Database of Systematic Reviews. The version in force was published on 28 March 2013; it followed a first version in 2011 and a protocol in 2009. Cochrane has neither updated nor withdrawn it, but its searches ran to December 2009, with some updated to October 2012, so it covers none of the trials below. It accepted only trials that compared acupuncture with sham, or acupuncture added to other care against that care alone, so that the result would show the effect of the acupuncture itself.
Four trials with 294 participants qualified, all from China and published in Chinese. Three used electroacupuncture, in which a small current passes between needles; one treated comatose patients, one acute injury and two rehabilitation. All four added acupuncture to hyperbaric oxygen, rehabilitation training or standard medical care and compared the result with that care alone; none used a sham, and none described how it randomised patients. The single trial reporting GCS found it 2 points higher with acupuncture (95% CI 0.27 to 3.73). Too few trials reported each outcome for any to be pooled. The authors judged that the low methodological quality did not allow a conclusion on efficacy or safety and called for high-quality trials. No included trial reported an adverse effect of acupuncture.
Later reviews
The reviews below mix comparisons that answer different questions: acupuncture against sham acupuncture, a control procedure made to look like the real one (Sham acupuncture describes the kinds in use); and acupuncture added to usual care against usual care alone, in which patients know which group they are in. An effective rate is the share of patients a trial judged to have improved by its own criterion.
| Review | Trials and people | Comparison | Main finding |
|---|---|---|---|
| Tan and colleagues 2019, disorders of consciousness, searched to February 2018 | 49, with 3,511 people | Acupuncture alone or added to basic treatment, against basic treatment; no sham | GCS 2.03 points higher; effective rate RR 1.48; mortality RR 0.50 |
| Zhang and colleagues 2020, coma, searched to March 2018 | 24 | Placebo, sham, conventional or other treatment, pooled | GOS RR 1.95; GCS 1.78 points higher (I² 52%) |
| Li G and colleagues 2025, consciousness | 11, with 896 people | Acupuncture with hyperbaric oxygen against hyperbaric oxygen alone | GCS 2.13 points higher (95% CI 1.64 to 2.62) |
| Li H and colleagues 2026, cognition, network meta-analysis searched to August 2025 | 9, with 528 people, eight treatments | Non-drug treatments compared through a network | A positive trend for electroacupuncture with hyperbaric oxygen on daily living; low or very low certainty on GRADE |
| Wang Y and colleagues 2026, sleep, network meta-analysis searched to November 2025 | 22, with 1,299 people; 2 of acupuncture | Drug and non-drug treatments against control treatments | The 2 acupuncture trials reported better insomnia and sleep-quality scores than control; drugs showed no advantage |
Tan’s review, from Guangzhou University of Chinese Medicine, included only trials conducted in China and published in Chinese. None used a sham or placebo, patients knew whether they were receiving acupuncture, and the authors called the trials generally of poor quality, with obvious publication bias favouring positive studies. Zhang’s review, from Tianjin University of Traditional Chinese Medicine, concluded that the evidence was too weak for practitioners to recommend acupuncture routinely. Li G’s review, from Yunnan University of Chinese Medicine, rated the trials’ methodological quality below standard and found the GCS difference larger when acupuncture started early than late. In Li H’s cognition network most comparisons rested on a single study and the estimates were imprecise; the authors judged the findings insufficient to rank any treatment. GRADE is the scale reviewers use to rate certainty, from high to very low.
An umbrella review by Yang and colleagues, searched to June 2024, gathered 7 evidence syntheses covering 121 trials of eight treatments for consciousness after TBI and listed acupuncture among the leading strategies. Its acupuncture estimates for GCS (MD 2.03) and effective rate (RR 1.48) are the point estimates Tan’s 2019 review reported, which indicates they come from the same body of trials rather than new evidence.
Trials in mild injury
The sham-controlled trials are in mild TBI. At a US Department of Veterans Affairs medical center between 2010 and 2015, Huang and colleagues randomised 60 veterans aged 24 to 55 with mild TBI at least 3 months old and sleep problems that had not responded to treatment; two thirds also had post-traumatic stress disorder (PTSD). The trial, published in the Journal of Clinical Psychiatry in 2018, gave up to 10 sessions of real or sham acupuncture. The Pittsburgh Sleep Quality Index (PSQI), a questionnaire on which a higher score means worse sleep, averaged 14.3 at the start and improved by 4.4 points with real acupuncture against 2.4 with sham. Sleep efficiency on a wrist monitor rose 2.7% with real acupuncture and fell 5.3% with sham. The authors reported that blinding held and that the effect appeared with and without PTSD.
In China, Wang ZN and colleagues at Xi’an Jiaotong University enrolled 66 people with mild TBI between 2016 and 2020 and assigned 22 each to real acupuncture, sham acupuncture or a waiting list, with 14 sessions over 4 weeks. The trial, published in Radiology in 2025, found the post-concussion symptom score 5.2 points lower after real acupuncture and no significant change with sham (1.2) or waiting (1.5); at 6 to 12 months the real-acupuncture group stood 8.1 points below baseline. The authors reported that on MRI a larger gain in the integrity of one white-matter tract, the right posterior corona radiata, went with a more lasting fall in symptoms.
The one trial of post-traumatic headache had no sham. Jonas and colleagues at three military treatment facilities in the Washington area, Walter Reed among them, randomised service members with mild to moderate TBI and headache to usual care alone or usual care with ear acupuncture or traditional Chinese acupuncture, 10 sessions over 6 weeks. Their exploratory study, published in Medical Acupuncture in 2016, assigned 43 people, of whom 29 completed the week-6 measures. On the Headache Impact Test, scores fell 6.4 points with ear acupuncture and 2.9 with traditional acupuncture and rose 0.6 with usual care; there was no difference in sleep, depression, anxiety or quality of life. Nine adverse events were judged at least possibly related to acupuncture, none of them serious.
A 2023 trial by Jia and colleagues at Cangzhou Central Hospital randomised 83 people with mild TBI to standard care or standard care plus 2 weeks of daily electroacupuncture at PC06 (Neiguan) and GV26 (Shuigou). Scores on two cognitive screening tests, the Montreal Cognitive Assessment and the Mini-Mental State Examination, rose more with electroacupuncture at the end of treatment and 8 weeks later. The control group received no sham. Tension-type headache and Insomnia report the trials of acupuncture for those complaints without a brain injury.
What guidelines say
The VA/DoD clinical practice guideline for the management and rehabilitation of post-acute mild TBI, version 3.0, dated June 2021, is the version the Department of Veterans Affairs currently publishes. Its recommendation 17 states that there is insufficient evidence to recommend for or against acupuncture, tai chi, meditation, mindfulness, yoga, massage, chiropractic therapy, cranial electrotherapy stimulation or sensory deprivation tanks for symptoms attributed to mild TBI. Its evidence review found one small trial of acupuncture, the Jonas study, which it counts as 29 participants, rated its confidence in that evidence very low, and judged the benefits unclear, the harms minimal and the two balanced. It notes that the VA/DoD headache guideline of 2020 also found insufficient evidence for or against acupuncture in headache generally, and it lists research the field still needs, including whether ear acupuncture, battlefield acupuncture among it, helps acute or chronic mild TBI symptoms.
What the reviews could not settle
The reviews of coma and consciousness could not separate the needling from the care around it. All four trials in the Cochrane review added acupuncture to care the control group also received, and every one of Tan’s 49 compared acupuncture with basic treatment, with no sham and no blinding of patients; the later umbrella review reports Tan’s estimates rather than testing them. Sham-controlled evidence exists only in mild TBI, and it rests on two single trials of 60 and 66 people, one on sleep and one on post-concussion symptoms, neither pooled with any other. No review has pooled trials of post-traumatic headache; the only trial, in service members, lost a third of its participants before the main measurement and had no sham. Cochrane’s own question, whether acupuncture helps in acute management or rehabilitation of TBI, has not been re-searched since 2012.
AcuiQ’s traumatic brain injury page lists the protocols individual studies prescribed, each with its citation, and Stroke recovery reports the larger body of trials in the other common acquired brain injury.