Objectives To systematically review the efficacy of acupuncture for improving migraine symptoms and cerebral blood flow velocity. Methods CBM, CNKI, VIP, WanFang Data, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on acupuncture for improving migraine symptoms and cerebral blood flow velocity from inception to September, 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 17 RCTs involving 2 226 patients were included. The results of meta-analysis showed that, acupuncture could effectively reduce the frequency of migraine compared with placebo acupuncture (SMD=−0.97, 95%CI −1.60 to −0.34, P=0.002) and medicine group (SMD=−1.29, 95%CI −1.85 to −0.73, P<0.000 01). Acupuncture could shorten duration of headache compared with placebo acupuncture (SMD=−0.73, 95%CI −1.25 to −0.21, P=0.006) and medicine group (SMD=−0.88, 95%CI −1.32 to −0.45, P<0.000 1). Compared with placebo acupuncture, acupuncture could relieve headache intensity (SMD=−0.67, 95%CI −1.15 to −0.19, P=0.006). The acupuncture group was superior to the placebo acupuncture group (SMD=−10.99, 95%CI −16.62 to −5.36, P=0.000 1) and medicine group (SMD=−0.63, 95%CI −0.87 to −0.40, P<0.000 01) in improving the cerebral blood flow velocity. Conclusions Current evidence shows that acupuncture can effectively reduce frequency of migraine, shorten duration of migraine, relieve intensity of migraine and improve cerebral blood flow velocity. Due to limited quality of the included studies, more high quality studies are required to verify above conclusion. © 2019 West China University of Medical Science. All rights reserved.