Integrative and Complementary Treatments for Migraine Are Needed

Part of learning tolerance and sometimes even acceptance of our relationship with migraine is coming to realize that living with it requires a lot of work for our medical professionals, but, even more, for us, as we struggle to keep up with appointments to see headache specialists/neurologists for consultations, medications, Botox, nerve blocks, and infusions. Then there are the different combinations of preventative and abortive medications we try until the right mix breaks the cycle or keeps us from moving from episodic to chronic migraine.

Because these treatments alone often don’t offer enough due to the complex symptoms associated with migraine, many migraine sufferers turn to complementary and integrative medicines including devices like Cefaly, mind/body treatments such as yoga and mindfulness meditation, manipulation and hands-on treatment by chiropractors and physical therapists, and dietary supplements like magnesium and vitamin B2.

Interestingly, many migraine patients don’t converse with their headache specialists/neurologists about using some of these treatments: In a recent social media survey, 90% of patients with migraine said they use complementary and integrative medicines like meditation, yoga, and vitamins, but only about 20% discuss these treatment strategies with a health care provider: “It is important for providers to be conversant with complementary and integrative medicine (CIM) treatments and the available evidence-based data,” Deena E. Kuruvilla, MD, a neurologist at Yale-New Haven Health, and colleagues wrote in BMC Complementary Medicine and Therapies (Miller) It seems critical that the patients/doctor have a relationship of trust, where they share what options they’ve tried in order for their medical professionals to have a complete history and potentially suggest other options, as well.

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may be as effective as pharmacological treatment for medication-overuse headache after the offending medication is withdrawn.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 and riboflavin to be helpful in migraine treatment, new research is promising to suggest potential benefits with melatonin, vitamin D, higher dosages of vitamin B6, and the combination of magnesium/feverfew 100 mg. Physical therapy (PT) continues to have strong evidence of support (Wells).

What follows is a partial selection of integrative/complementary treatments:

Dietary Supplements

• Magnesium, a mineral in the body important for energy production, muscle/nerve function, may also play a role in cortical spreading depression, an underlying migraine mechanism. Two large randomized controlled trials found 600 mg/day beneficial for migraine prevention.
• Riboflavin (Vitamin B2) is involved in energy production, and its deficiency can cause mitochondrial dysfunction, which may play a role in migraine. Of 11 clinical trials, 5 showed a positive effect, including a large randomized controlled trial of 400 mg/day that resulted in at least a 50% improvement in 60% of patients.

Mind/Body

• Mindfulness Meditation has been defined by Dr. Jon Kabat-Zinn as “paying attention in a particular way, on purpose, in the present moment, non-judgmentally.” Mindfulness meditation has been shown to improve overall well-being, decrease stress and anxiety, reduce the recurrence of depression, benefitting those with chronic migraine.
• Yoga: One randomized controlled trial found that 3 months of 5 days/week, 60-minute yoga sessions decreased the frequency and severity of migraine, as well as associated anxiety, and depression.

Manipulation-Based Treatment

• Chiropractic Treatment: I receive chiropractic treatment for the management of chronic migraine, particularly when I am in an intractable period and/or when my TMJ is acting up. While I receive BOTOX for the TMJ, as well as for migraine, my chiropractor treats and releases the superficial and deeper parts of the masseter, working from both the inside and outside of the jaw.
• Physical Therapy: According to Jenni Tuller, owner of and physical therapist for Physical Therapy Services of Rochester (Rochester, NY), who works primarily with chronic migraine patients, the most common types of headaches treated by physical therapy are tension/stress type, migraine with or without aura, vestibular migraine, cluster, and new daily persistent headaches. If someone is diagnosed with migraine, treatment will not cure the migraine, but rather eliminate the cervicogenic trigger(s). A home program is then prescribed to further reduce symptoms and maintain changes obtained through treatment (Physical Therapy Services of Rochester).

I have seen my physical therapist for weekly/sometimes bi-weekly treatment for several years, after being referred by my headache specialist. My work with her (Jenni Tuller) is an integral part of my regular migraine treatment. What’s important here is to find the right physical therapist, one who truly understands the complexities of migraine and stays current with the research and physical therapy treatments that are effective.

Devices

• Cefaly: The first dual-purpose, external trigeminal nerve stimulation device to treat and prevent acute migraine is now available over the counter to adults over age 18. The US Food and Drug Administration (FDA) has recently cleared Cefaly Dual (Cefaly Technology), which was previously only available by prescription. Most migraines involve the trigeminal nerve, which can be accessed through the skin on the forehead. Cefaly Dual stimulates the trigeminal nerve using a reusable self-adhesive electrode placed on the forehead (Brooks).

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I have used the Cefaly device since it first became FDA approved and widely available in 2014. The recommended one-hour session with the Cefaly device is one I use almost daily for both preventative and acute treatment. While some people may find the stimulation a little disconcerting or uncomfortable at the beginning as it builds through the first half of the session, I find it soothing and somehow comforting to feel the electrical stimulation as it follows the trigeminal nerve.

• The Vagus Nerve Stimulator, a recent non-invasive, FDA approved device, is, according to Dr. Katherine Hamilton, a neurologist and assistant professor of clinical neurology at the University of Pennsylvania, is a viable option for patients who suffer from frequent attacks and want to limit their medications, which can cause side-effects and medication overuse. The biggest barrier, she points out, though, is cost; most patients at this point have to rent the device, and getting insurance coverage is difficult (“Vagus Nerve Stimulation”).

As always, what remains important in the various treatments one uses to manage migraine is to stay abreast of the options out there as well as to look to the hopeful new treatments down the road. Be sure your medical professional team stays abreast of these, as well, and always encourages you that there are alternatives to what you are now trying. Because there is no cure for migraine, no one avenue of treatment will likely prove enough in the management of migraine. Seek as many varied treatments as you can to care for your mind and body while coping with this disease.