British researchers discuss new alternatives to drugs for treating migraine headaches, including neutraceuticals, neuromodulation, and behavioural therapy.

Migraines are a common disease afflicting up to 50% of men and 20% of women over the course of a lifetime. Because they often affect young people, migraines are the sixth-ranked cause of disability in the world.

Many oral medications used to treat migraines cause disagreeable side effects and are less effective than expected. A review article published in Neurotherapeutics discusses some of the new therapies and techniques for treating migraines.


“Nutraceuticals” are one treatment option. These are defined as food or dietary supplements that provide health or medicinal benefits. Vitamin B2 (riboflavin), coenzyme Q10, magnesium, butterbur root extract (Petasites hybridus), and feverfew (Tanacetum parthenium) are nutraceuticals that have shown some use in migraine prevention.

Clinical studies of vitamin B2 and coenzyme Q10 suggest that these supplements may reduce the frequency of migraine attacks. Of the two supplements, only vitamin B2 is currently recommended as a low-risk preventative treatment for migraines. The other nutraceuticals show some benefit, 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 Therapy

Behavioural interventions, such as relaxation, biofeedback training, and cognitive behavioural therapy are also used to treat migraines. 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. Devices send either 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.

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 treatment of migraines and develop more individualized treatment methods.

Written by Cindi A. Hoover, Ph.D.

Reference: Puledda F and Shields K. Non-Pharmacological Approaches for Migraine. 2018. Neurotherapeutics. https://doi.org/10.1007/s13311-018-0623-6

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