Migraines are a common disease afflicting up to 50% of men and 20% of women over the course of a lifetime.1 Many oral medications that treat migraines cause disagreeable side effects and are less effective than expected. A review article published in Neurotherapeutics discusses some of the alternative treatments and techniques for migraine headaches.
Nutraceuticals are defined as food or dietary supplements that provide health or medicinal benefits.1 Vitamin B2 (riboflavin), coenzyme Q10, magnesium, butterbur root extract (Petasites hybridus), and feverfew (Tanacetum parthenium) are nutraceuticals that have shown some benefits in migraine prevention.1
Clinical studies of vitamin B2 and coenzyme Q10 suggest that these supplements may reduce the frequency of migraine attacks.1 Of the two supplements, only vitamin B2 is currently recommended as a low-risk preventative treatment for migraines. The other nutraceuticals show some benefits, but mixed clinical study results mean that more research is needed. Butterbur extract is not recommended because of safety concerns related to liver toxicity.
Behavioural interventions, such as relaxation, biofeedback training, and cognitive behavioural therapy are also used to treat migraines.1 These strategies focus on teaching patients to identify migraine triggers and better cope with their symptoms. When combined with migraine medication, clinical studies show that these techniques are more effective at reducing headaches than medication alone. Patients may also be able to reduce the amount of medication they take for migraines.
A new area of treatment, called non-invasive neuromodulation, involves nerve stimulation to reduce migraine-related pain.1 Devices send magnetic or electrical pulses through the skin to stimulate nerves in the brain. Of the several types of nerve stimulation treatments, single-pulse transcranial magnetic nerve stimulation and transcutaneous cranial nerve stimulation show the most promise for reducing migraine frequency and pain. However, these types of treatments are only available at specialized centres.
Alternative treatments provide options
The authors conclude that the use of non-pharmaceuticals to treat migraine headaches is quickly expanding. They urge clinicians to investigate whether these options are appropriate for any patients who express concern about using pharmacologic treatments, or who present with complex cases. Neuromodulation, nutraceuticals, and behavioural therapy are three options with evidence of effectiveness and few side effects. Larger-scale clinical trials are needed to improve the treatment of migraines and develop more individualized treatment methods.
- Puledda, F., Shields, K. Non-pharmacological approaches for migraine. Neurotherapeutics 15, 336–345 (2018). https://doi.org/10.1007/s13311-018-0623-6