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

Abstract

Objective-The purpose of this review is to evaluate evidence from the last three years on complementary and integrative medicine treatment options for episodic migraine.Methods-Using Pubmed, Embase, and Cochrane databases, research published from 2015-2018 evaluating themodalities of mind/body therapies, supplements, and manual therapies for treatment of migraine were assessed.Results-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may be as effective as pharmacological treatment for medication overuse headache after the offending medication is withdrawn.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 (80mg)/folic acid 5mg combinations, and the combination of Magnesium 112.5mg/CoQ10 100 mg/feverfew 100 mg. Omega 3's have limited evidence of efficacy in migraine. Butterbur needs to be free of Pyrrolidizine 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.

Real world, open label prospective experience of supplementation with a fixed combination of magnesium, vitamin B2, feverfew, andrographis paniculata and coenzyme Q10 (Vivinor®) for episodic migraine prophylaxis

“…Indeed, existing knowledge shows that magnesium, vitamin B2, feverfew and coenzyme Q10 are helpful in migraine prophylaxis with minimal safety issues, as these nutrients might be able to target some of the processes involved in migraine pathogenesis. 28 Speci cally, magnesium blocks glutamate receptors, modulates ATP production and glucose metabolism and as such high dose supplementation is able to decrease glutamate-activated cortical spreading depression. Likewise, high dose supplementation with vitamin B2 and coenzyme Q10 may augment activity of mitochondrial complexes to prevent mitochondrial dysfunction.…”

Daith Piercing: Wonder Treatment or Untested Fad?

“…It was shrouded in a belief that the piercing acts as a gateway for only knowledge to pass through the ear [2]. The piercing gained mainstream popularity in the following years and has been subsequently used for migraine as an alternate treatment by some patients with anecdotal patient reports online suggesting an improvement in symptoms [3]. This case illustrates a current common health-related practice in the community, the awareness of which could help the provider to manage this condition better.…”

Development and Implementation of the Integrative Toolbox for Headache Management

“…As a result, individuals with migraine often prefer to avoid daily medication and instead seek non‐pharmacologic options, including complementary and integrative health (CIH) therapies . There is some evidence that these therapies may be helpful for patients with episodic migraine …”

“…9,10 There is some evidence that these therapies may be helpful for patients with episodic migraine. 11 While many patients reported using CIH therapies, others did not know what CIH therapies are available or how to access them. In addition, some patients reported that they had tried different combinations of complementary therapies, often without success or evidence of efficacy.…”