Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Current Pain and Headache Reports
Published in: Current Pain and Headache Reports 2/2019

01-02-2019 | Migraine | Episodic Migraine (S. Nahas, Section Editor)

Complementary and Integrative Medicine for Episodic Migraine: an Update of Evidence from the Last 3 Years

Authors: Rebecca Erwin Wells, Justin Beuthin, Laura Granetzke

Published in: Current Pain and Headache Reports | Issue 2/2019

Login to get access

Abstract

Purpose of Review

The purpose of this review is to evaluate evidence from the last 3 years on complementary and integrative medicine treatment options for episodic migraine. Using Pubmed, Embase, and Cochrane databases, research published from 2015-2018 evaluating the modalities of mind/body therapies, supplements, and manual therapies for treatment of migraine were assessed.

Recent Findings

Although many studies had major methodological challenges that limit interpretation, several studies reported decreased headache frequency, improved quality of life, or less affective responses to pain. The evidence is currently most promising for the mind/body treatment options of mindfulness, yoga, and tai chi. Mindfulness meditation may be as effective as pharmacological treatment for medication-overuse headache after the offending medication is withdrawn. While older research has shown magnesium, riboflavin, feverfew, and butterbur to be helpful in migraine treatment, new research is promising to suggest potential benefit with melatonin, vitamin D, higher dosages of vitamin B6 (80 mg)/folic acid 5 mg combinations, and the combination of magnesium 112.5 mg/CoQ10 100 mg/feverfew 100 mg. Omega 3s have limited evidence of efficacy in migraine. Butterbur needs to be free of pyrrolizidine alkaloids (PA) to ensure safety given their hepatotoxicity. Physical therapy (PT) continues to have strong evidence of support, and acupuncture is superior to sham acupuncture and placebo. Side effects and risks reported were minimal and well tolerated overall, with the exception of the life-threatening risk of cervical artery dissection with high-velocity chiropractic manipulation and hepatotoxicity with the PAs in butterbur. Several studies are ongoing to further evaluate mindfulness, melatonin, PT, exercise, chiropractic manipulation, and acupuncture. The American Academy of Neurology (AAN) and American Headache Society (AHS) are currently updating the guidelines for integrative treatment options for migraine, so additional recommendations may be available soon.

Summary

In conclusion, many complementary and integrative treatment options may be helpful for patients with migraines, and understanding potential efficacy, benefits, and risks can help providers discuss these modalities with their patients. Such a conversation can empower patients, build the therapeutic relationship, and increase self-efficacy, thus improving outcomes and patient-centered care.
Literature
1.
Wells RE, Bertisch SM, Buettner C, Phillips RS, McCarthy EP. Complementary and alternative medicine use among adults with migraines/severe headaches. Headache. 2011;51(7):1087–97.PubMedPubMedCentral
2.
Zhang Y, Dennis JA, Leach MJ, Bishop FL, Cramer H, Chung VCH, et al. Complementary and alternative medicine use among US adults with headache or migraine: results from the 2012 National Health Interview Survey. Headache. 2017;57(8):1228–42.PubMed
3.
Smitherman TA, Wells RE, Ford SG. Emerging behavioral treatments for migraine. Curr Pain Headache Rep. 2015;19(4):13.PubMed
4.
Millstine D, Chen CY, Bauer B. Complementary and integrative medicine in the management of headache. BMJ. 2017;357:j1805.PubMed
5.
Wells RE, Baute V, Wahbeh H. Complementary and integrative medicine for neurologic conditions. Med Clin North Am. 2017 Sep;101(5):881–93.PubMedPubMedCentral
6.
Feuille M, Pargament K. Pain, mindfulness, and spirituality: a randomized controlled trial comparing effects of mindfulness and relaxation on pain-related outcomes in migraineurs. J Health Psychol. 2015;20(8):1090–106.PubMed
7.
Wachholtz AB, Malone CD, Pargament KI. Effect of different meditation types on migraine headache medication use. Behav Med Wash DC. 2017;43(1):1–8.
8.
Bakhshani NM, Amirani A, Amirifard H, Shahrakipoor M. The effectiveness of mindfulness-based stress reduction on perceived pain intensity and quality of life in patients with chronic headache. Glob J Health Sci. 2015;8(4):142–51.PubMedPubMedCentral
9.
Andrasik F, Grazzi L, D’Amico D, Sansone E, Leonardi M, Raggi A, et al. Mindfulness and headache: a “new” old treatment, with new findings. Cephalalgia Int J Headache. 2016;36(12):1192–205.
10.
Grazzi L, D’Amico D, Raggi A, Leonardi M, Ciusani E, Corsini E, et al. Mindfulness and pharmacological prophylaxis have comparable effect on biomarkers of inflammation and clinical indexes in chronic migraine with medication overuse: results at 12 months after withdrawal. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol. 2017;38(Suppl 1):173–5.
11.
Grazzi L, Raggi A, D’Amico D, Sansone E, Leonardi M, Andrasik F, et al. A prospective pilot study of the effect on catecholamines of mindfulness training vs pharmacological prophylaxis in patients with chronic migraine and medication overuse headache. Cephalalgia Int J Headache. 2018;13:333102418801584.
12.
Grazzi L, Sansone E, Raggi A, D’Amico D, De Giorgio A, Leonardi M, et al. Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with chronic migraine: an effectiveness trial with a one-year follow-up. J Headache Pain. 2017;18(1):15.PubMedPubMedCentral
13.
Keller A, Meyer B, Wöhlbier H-G, Overath CH, Kropp P. Migraine and meditation: characteristics of cortical activity and stress coping in migraine patients, meditators and healthy controls-an exploratory cross-sectional study. Appl Psychophysiol Biofeedback. 2016;41(3):307–13.PubMed
14.
Komandur B, Martin PR, Bandarian-Balooch S. Mindfulness and chronic headache/migraine: mechanisms explored through the fear-avoidance model of chronic pain. Clin J Pain. 2018;34(7):638–49.PubMed
15.
Azam MA, Katz J, Mohabir V, Ritvo P. Individuals with tension and migraine headaches exhibit increased heart rate variability during post-stress mindfulness meditation practice but a decrease during a post-stress control condition - a randomized, controlled experiment. Int J Psychophysiol Off J Int Organ Psychophysiol. 2016;110:66–74.
16.
•• Gu Q, Hou J-C, Fang X-M. Mindfulness meditation for primary headache pain: a meta-analysis. Chin Med J (Engl). 2018;131(7):829–38 An important meta-analyses of mindfulness for headaches with ten studies ( n =315) that showed that mindfulness meditation significantly improved pain intensity and headache frequency.
17.
Anheyer D, Leach MJ, Klose P, Dobos G, Cramer H. Mindfulness-based stress reduction for treating chronic headache: a systematic review and meta-analysis. Cephalalgia Int J Headache. 2018;1:333102418781795.
18.
Kisan R, Sujan M, Adoor M, Rao R, Nalini A, Kutty BM, et al. Effect of yoga on migraine: a comprehensive study using clinical profile and cardiac autonomic functions. Int J Yoga. 2014;7(2):126–32.PubMedPubMedCentral
19.
Naji-Esfahani H, Zamani M, Marandi SM, Shaygannejad V, Javanmard SH. Preventive effects of a three-month yoga intervention on endothelial function in patients with migraine. Int J Prev Med. 2014;5(4):424–9.PubMedPubMedCentral
20.
John PJ, Sharma N, Sharma CM, Kankane A. Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache. 2007;47(5):654–61.PubMed
21.
Sharma VM, Manjunath NK, Nagendra HR, Ertsey C. Combination of ayurveda and yoga therapy reduces pain intensity and improves quality of life in patients with migraine headache. Complement Ther Clin Pract. 2018;32:85–91.
22.
Boroujeni MZ, Marandi SM, Esfarjani F, Sattar M, Shaygannejad V, Javanmard SH. Yoga intervention on blood NO in female migraineurs. Adv Biomed Res. 2015;4:259.
23.
Xie YJ, Hui SS-C, Ho SC, Suen LKP. The effectiveness of 12-week tai chi training in the prophylaxis of episodic migraine: a pilot randomized controlled trial in Chinese women. Cephalalgia. 2017;37:334.
24.
25.
Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E, et al. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012 Apr 24;78(17):1346–53.PubMedPubMedCentral
26.
•• Diener H, Freitag F, Danesch U. Safety profile of a special butterbur extract from Petasites hybridus in migraine prevention with emphasis on the liver. Cephalalgia Rep. 2018;1:2515816318759304 An excellent review of the butterbur root extract Petadolex and its safety and risks.
27.
Gaul C, Diener H-C, Danesch U, Migravent® Study Group. Improvement of migraine symptoms with a proprietary supplement containing riboflavin, magnesium and Q10: a randomized, placebo-controlled, double-blind, multicenter trial. J Headache Pain. 2015;16:516.PubMed
28.
Guilbot A, Bangratz M, Ait Abdellah S, Lucas C. A combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: a prospective observational study. BMC Complement Altern Med. 2017;17(1):433.PubMedPubMedCentral
29.
Menon S, Nasir B, Avgan N, Ghassabian S, Oliver C, Lea R, et al. The effect of 1 mg folic acid supplementation on clinical outcomes in female migraine with aura patients. J Headache Pain. 2016;17(1):60.PubMedPubMedCentral
30.
Askari G, Nasiri M, Mozaffari-Khosravi H, Rezaie M, Bagheri-Bidakhavidi M, Sadeghi O. The effects of folic acid and pyridoxine supplementation on characteristics of migraine attacks in migraine patients with aura: a double-blind, randomized placebo-controlled, clinical trial. Nutr Burbank Los Angel Cty Calif. 2017;38:74–9.
31.
Sadeghi O, Nasiri M, Maghsoudi Z, Pahlavani N, Rezaie M, Askari G. Effects of pyridoxine supplementation on severity, frequency and duration of migraine attacks in migraine patients with aura: a double-blind randomized clinical trial study in Iran. Iran J Neurol. 2015;14(2):74–80.PubMedPubMedCentral
32.
Gonçalves AL, Martini Ferreira A, Ribeiro RT, Zukerman E, Cipolla-Neto J, Peres MFP. Randomised clinical trial comparing melatonin 3 mg, amitriptyline 25 mg and placebo for migraine prevention. J Neurol Neurosurg Psychiatry. 2016;87(10):1127–32.PubMedPubMedCentral
33.
Bougea A, Spantideas N, Lyras V, Avramidis T, Thomaidis T. Melatonin 4 mg as prophylactic therapy for primary headaches: a pilot study. Funct Neurol. 2016;31(1):33–7.PubMedPubMedCentral
34.
Fallah R, Fazelishoroki F, Sekhavat L. A randomized clinical trial comparing the efficacy of melatonin and amitriptyline in migraine prophylaxis of children. Iran J Child Neurol. 2018;12(1):47–54.PubMedPubMedCentral
35.
Iannacchero R, Costa A, Squillace A, Gallelli L, Cannistrà U, De Sarro G. P060. Vitamin D deficiency in episodic migraine, chronic migraine and medication-overuse headache patients. J Headache Pain. 2015;16(Suppl 1):A184.PubMedPubMedCentral
36.
Celikbilek A, Gocmen AY, Zararsiz G, Tanik N, Ak H, Borekci E, et al. Serum levels of vitamin D, vitamin D-binding protein and vitamin D receptor in migraine patients from Central Anatolia region. Int J Clin Pract. 2014 Oct;68(10):1272–7.PubMed
37.
Kjaergaard M, Eggen AE, Mathiesen EB, Jorde R. Association between headache and serum 25-hydroxyvitamin D: the Tromsø Study: Tromsø 6. Headache. 2012;52(10):1499–505.PubMed
38.
Zandifar A, Masjedi SS, Banihashemi M, Asgari F, Manouchehri N, Ebrahimi H, et al. Vitamin D status in migraine patients: a case-control study. Biomed Res Int. 2014;2014:514782.PubMedPubMedCentral
39.
Donmez A, Orun E, Sonmez FM. Vitamin D status in children with headache: a case-control study. Clin Nutr ESPEN. 2018;23:222–7.PubMed
40.
Buettner C, Burstein R. Association of statin use and risk for severe headache or migraine by serum vitamin D status: a cross-sectional population-based study. Cephalalgia Int J Headache. 2015;35(9):757–66.
41.
Mottaghi T, Askari G, Khorvash F, Maracy MR. Effect of vitamin D supplementation on symptoms and C-reactive protein in migraine patients. J Res Med Sci Off J Isfahan Univ Med Sci. 2015;20(5):477–82.
42.
• Gazerani P, Fuglsang R, Pedersen JG, Sørensen J, Kjeldsen JL, Yassin H, et al. A randomized, double-blinded, placebo-controlled, parallel trial of vitamin D3 supplementation in adult patients with migraine. Curr Med Res Opin. 2018;28:1–9 A randomized controlled trial that demonstrated Vitamin D supplementation may improve migraines even in those without low levels at baseline.
43.
Martins LB, Rodrigues AMDS, Rodrigues DF, Dos Santos LC, Teixeira AL, Ferreira AVM. Double-blind placebo-controlled randomized clinical trial of ginger ( Zingiber officinale Rosc.) addition in migraine acute treatment. Cephalalgia. 2018;0(0):1–9.
44.
Maghsoumi-Norouzabad L, Mansoori A, Abed R, Shishehbor F. Effects of omega-3 fatty acids on the frequency, severity, and duration of migraine attacks: a systematic review and meta-analysis of randomized controlled trials. Nutr Neurosci. 2018;21(9):614–23.PubMed
45.
Soares A de A, Louçana PMC, Nasi EP, Sousa KM de H, Sá OM de S, Silva-Néto RP. A doubleblind, randomized, and placebo-controlled clinical trial with omega-3 polyunsaturated fatty acids (OPFA ɷ-3) for the prevention of migraine in chronic migraine patients using amitriptyline. Nutr Neurosci. 2018;21(3):219–23.
46.
D’Andrea G, Bussone G, Allais G, Aguggia M, D’Onofrio F, Maggio M, et al. Efficacy of Ginkgolide B in the prophylaxis of migraine with aura. Neurol Sci. 2009;30(1):121–4.
47.
Esposito M, Carotenuto M. Ginkgolide B complex efficacy for brief prophylaxis of migraine in school-aged children: an open-label study. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol. 2011;32(1):79–81.
48.
Bevilaqua-Grossi D, Gonçalves MC, Carvalho GF, Florencio LL, Dach F, Speciali JG, et al. Additional effects of a physical therapy protocol on headache frequency, pressure pain threshold, and improvement perception in patients with migraine and associated neck pain: a randomized controlled trial. Arch Phys Med Rehabil. 2016;97(6):866–74.PubMed
49.
Espí-López G-V, Ruescas-Nicolau M-A, Nova-Redondo C, Benítez-Martínez JC, Dugailly P-M, Falla D. Effect of soft tissue techniques on headache impact, disability, and quality of life in migraine sufferers: a pilot study. J Altern Complement Med [Internet]. 2018. [cited 2018 May 15]; Available from: https://​doi.​org/​10.​1089/​acm.​2018.​0048
50.
Cerritelli F, Ginevri L, Messi G, Caprari E, Di Vincenzo M, Renzetti C, et al. Clinical effectiveness of osteopathic treatment in chronic migraine: 3-armed randomized controlled trial. Complement Ther Med. 2015;23(2):149–56.PubMed
51.
D’Ippolito M, Tramontano M, Buzzi MG. Effects of osteopathic manipulative therapy on pain and mood disorders in patients with high-frequency migraine. J Am Osteopath Assoc. 2017;117(6):365–9.PubMed
52.
Chaibi A, Benth JŠ, Tuchin PJ, Russell MB. Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. Eur J Neurol. 2017;24(1):143–53.PubMed
53.
54.
Turner RC, Lucke-Wold BP, Boo S, Rosen CL, Sedney CL. The potential dangers of neck manipulation & risk for dissection and devastating stroke: An illustrative case & review of the literature. Biomed Res Rev. 2018;2(1).
55.
Irby MB, Bond DS, Lipton RB, Nicklas B, Houle TT, Penzien DB. Aerobic exercise for reducing migraine burden: mechanisms, markers, and models of change processes. Headache. 2016;56(2):357–69.PubMed
56.
Krøll LS, Sjödahl Hammarlund C, Gard G, Jensen RH, Bendtsen L. Has aerobic exercise effect on pain perception in persons with migraine and coexisting tension-type headache and neck pain? A randomized, controlled, clinical trial. Eur J Pain. 2018;22:1399–1408.
57.
Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016;6:CD001218.
58.
Yang Y, Que Q, Ye X, Zheng G. Hua. Verum versus sham manual acupuncture for migraine: a systematic review of randomised controlled trials. Acupunct Med J Br Med Acupunct Soc. 2016;34(2):76–83.
59.
Xu J, Zhang F-Q, Pei J, Ji J. Acupuncture for migraine without aura: a systematic review and meta-analysis. J Integr Med. 2018;16(5):312–21.PubMed
60.
Zhao L, Chen J, Li Y, Sun X, Chang X, Zheng H, et al. The long-term effect of acupuncture for migraine prophylaxis: a randomized clinical trial. JAMA Intern Med. 2017;177:508–15.PubMed
61.
Wang Y, Xue CC, Helme R, Da Costa C, Zheng Z. Acupuncture for frequent migraine: a randomized, patient/assessor blinded, Controlled Trial with One-Year Follow-Up. Evid-Based Complement Altern Med ECAM. 2015;2015:920353.
62.
Gu T, Lin L, Jiang Y, Chen J, D’Arcy RC, Chen M, et al. Acupuncture therapy in treating migraine: results of a magnetic resonance spectroscopy imaging study. J Pain Res. 2018;11:889–900.PubMedPubMedCentral
63.
Happe S, Peikert A, Siegert R, Evers S. The efficacy of lymphatic drainage and traditional massage in the prophylaxis of migraine: a randomized, controlled parallel group study. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol. 2016;37(10):1627–32.
64.
Safonov MI, Naprienko MV. Analysis of the efficacy of reflexology in the complex treatment of chronic migraine. Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(5):22–5.PubMed
65.
Imani N, Shams SA, Radfar M, Ghavami H, Khalkhali HR. Effect of applying reflexology massage on nitroglycerin-induced migraine-type headache: a placebo-controlled clinical trial. Agri Agri Algoloji Derneginin Yayin Organidir J Turk Soc Algol. 2018;30(3):116–22.
66.
67.
Blatchley C, Wilkins A. Daith Piercing, Vagus nerve stimulation and migraine prevention, 2018 Migraine Trust International Symposium, London 2018.
68.
69.
Sansone E, Raggi A, Grignani E, Leonardi M, D’Amico D, Scaratti C, et al. Mindfulness meditation for chronic migraine in pediatric population: a pilot study. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol. 2018;39(Suppl 1):111–3.
70.
Wells RE, Phillips RS, Schachter SC, McCarthy EP. Complementary and alternative medicine use among US adults with common neurological conditions. J Neurol. 2010;257(11):1822–31.PubMedPubMedCentral
71.
Aveni E, Bauer B, Ramelet A-S, Kottelat Y, Decosterd I, Finti G, et al. The attitudes of physicians, nurses, physical therapists, and midwives toward complementary medicine for chronic pain: a survey at an academic hospital. Explore N Y N. 2016 Oct;12(5):341–6.
72.
Oinonen SM. Integrative medicine: a necessary component in completing treatment for my chronic migraines. Headache. 2017;57:809–811
73.
Armstrong L, Gossard G. Taking an integrative approach to migraine headaches. J Fam Pract. 2016;65(3):165–76.PubMed
74.
Cowan RP. CAM in the real world: you may practice evidence-based medicine, but your patients don’t. Headache. 2014;54(6):1097–102.PubMed
Metadata
Title
Complementary and Integrative Medicine for Episodic Migraine: an Update of Evidence from the Last 3 Years
Authors
Rebecca Erwin Wells
Justin Beuthin
Laura Granetzke
Publication date
01-02-2019
Publisher
Springer US
Published in
Current Pain and Headache Reports / Issue 2/2019
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-019-0750-8

Other articles of this Issue 2/2019

Current Pain and Headache Reports 2/2019 Go to the issue

Hot Topics in Pain and Headache (N. Rosen, Section Editor)

Geographical Differences in Trigger Factors of Tension-Type Headaches and Migraines

Neuropathic Pain (A. Abd-Elsayed, Section Editor)

Safety and Efficacy of Radiofrequency Ablation of the Medial Branch Nerves with Preexisting Spinal Hardware. A Case Series and Review of Literature

Other Pain (A. Kaye and N. Vadivelu, Section Editors)

Perioperative Considerations in the Management of Anticoagulation Therapy for Patients Undergoing Surgery

Episodic Migraine (S. Nahas, Section Editor)

Unique Considerations for Special Populations in Episodic Migraine: the Underserved

Other Pain (A. Kaye and N. Vadivelu, Section Editors)

Oxycodone’s Unparalleled Addictive Potential: Is it Time for a Moratorium?

Other Pain (A. Kaye and N. Vadivelu, Section Editors)

Functional Improvements Utilizing the Short Physical Performance Battery (SPPB) in the Elderly after Epidural Steroid Injections