Scalp acupuncture (SA) has shown potential as a treatment for acute ischemic stroke. This study investigated the effects and mechanisms of SA in rodent stroke models using systematic review, animal experiments, and analysis of peripheral responses. Subsequent animal studies confirmed the anti-inflammatory effects of SA, showing reduced TNF-α, IL-1β, IL-6 and increased IL-10 in rat stroke brains. SA enhanced neurological outcomes, as measured by the 6-point neuroscore, cylinder test, and grip strength test. Although SA's reduction in stroke infarct area was not statistically significant, it notably increased neuron survival in the striatum. Analysis of peripheral responses revealed that SA induced mast cell degranulation and increased substance P and calcitonin gene-related peptide levels in the scalp and dura. This suggests that SA stimulates neurogenic inflammation through the trigeminal system. Taken together, this research suggests that SA may have therapeutic potential in acute ischemic stroke. Anti-inflammatory and neurological improvements in stroke models provide empirical evidence. Peripheral responses suggest neural mechanisms worthy of further investigation.