OBJECTIVE: To explore how baseline resting-state cerebral function predicts clinical outcomes of acupuncture treatment for migraine.METHODS: One hundred migraine patients and 46 healthy subjects were recruited. Patients were randomized into the acupuncture, sham acupuncture,and waiting list groups. Resting-state functional magnetic resonance imaging data were collected at baseline and after 1 month of longitudinal acupuncture treatments. Fractional amplitude of low-frequency fluctuations(f ALFF) calculations were applied to explore the associations between baseline f ALFF and changes in clinical variables in the acupuncture treatment group and the waiting list group.RESULTS: Compared with healthy subjects, migraine patients had lower f ALFF in the left rostral ventromedial medulla, right thalamus, left amygdala, and right angular gyrus. Regression analyses revealed that baseline f ALFF values in the left middle frontal gyrus, left superior temporal gyrus, and middle temporal gyrus were positively associated with headache intensity changes in the acupuncture treatment group, while baseline f ALFF values in the bilateral lingual gyrus and cuneus were negatively associated with headache intensity changes in this group.CONCLUSION: The baseline f ALFF values of brain regions associated with cognitive pain modulation,but not migraine severity, may predict future headache intensity improvement levels in migraine patients receiving acupuncture treatment.