Middlesbrough deserved three points despite suffering three injury blows after going behind to an early goal.
Boro showed more attacking flair and looked on the way for a win after dominating the play for long spells.
Sunderland, however, had other ideas.
Jonathan Woodgate captained his home team with George Boateng relegated to the substitute's bench.
Sunderland snatched a lead after two minutes when Grant Leadbitter took full advantage following a mistake by former Wearside favourite Julio Arca.
Shortly after, Turkey international striker Sanli Tuncay was in obvious pain after an injury and Dong-Gook Lee took over from him.
Arca redeemed himself after his early mistake with a flying header for an equaliser after an excellent Gary O'Neil cross.
However, Arca was the second Middlesbrough player in the wars and Boateng took over from him in midfield.
Middlesbrough striker Mido was suffering from a hamstring problem but continued on the field until the 58th minute when local hero Lee Cattermole took over.
Despite a much changed side, Middlesbrough looked more impressive than the visitors and England winger Stewart Downing brought the home fans to their feet with a stunning goal.
Collecting a Boateng cross-field pass, Downing left Craig Gordon helpless with a terrific right-foot shot from outside the penalty area.
Sunderland made three substitutions in this full-blooded derby that was packed with incident and excitement.
On one occasion, tempers boiled over on the touchline before calm was restored with Cattermole and Leadbitter booked.
On this display Sunderland could have problems adjusting to the higher class of the Premier League.
But no-one could question their never-say-die spirit and substitute Miller became a hero of the travelling fans with a superb equaliser.
The former Manchester United midfielder fired a perfect shot from outside the penalty area which squeezed just inside the post.
Afterwards a disappointed Boro boss Gareth Southgate summed up: "It was a bit edgy at the end. The crowd went quiet after we had dominated play and looked comfortable.
"We had lots to contend with, losing an early goal which was unlucky, and then losing three players to injuries."