Integrative therapies offer effective complement to migraine treatment

Photo Cred: Anthony Tran/Unsplash

By Kat Black

Migraine patients sometimes experience complete remission from their symptoms through complementary treatments, according to Alexander Mauskop, MD, director of the New York Headache Center.

“Migraines are more susceptible to alternative therapies,” he said. “We take a … history, identify potential triggers: stress, lack of sleep, dietary factors, hormonal changes … After we go down that list, we try to fix the triggers and then we go with treatment.”

Mauskop cited serious medication side effects, such as increased pain from acute medication use, as just one of the reasons patients may be interested in a more holistic approach to migraine treatment.  

According to the Migraine Research Foundation, 39 million Americans experience migraines. The 2019 Global Burden of Disease study found that migraines rank second among the world’s causes of disability, and they are the leading cause of disability among young women.

A 2021 social media survey published in the journal BMC Complementary Medicine and Therapies found “between 28 percent and 82 percent of people with migraine use non-drug approaches.” Thirty-four  to 42 percent of those surveyed reported that these alternatives were at least mildly effective.

Patients seek complementary migraine therapies for several reasons. Migraine is a complex heterogeneous disorder and there’s ample opportunity for personalized approaches, according to Tesha Monteith, MD, associate professor of clinical neurology at the University of Miami Miller School of Medicine.

“Migraine…has peak disability when people are most highly functional,” said Monteith. “Getting that under control in an integrative manner is really important for long-term management.”  

Neuromodulation Devices

Neuromodulation devices use electrical currents or magnets to adjust neural activity through nerve stimulation. These non-invasive technologies, which can be used to treat both chronic and episodic migraine, include vagus nerve stimulation (VNS), external trigeminal nerve stimulation (e-TNS) or transcutaneous electrical nerve stimulation (TENS), occipital nerve stimulation (ONS), remote electrical neuromodulation (REN), and single-pulse transcranial magnetic stimulation (sTMS). These devices may be of particular interest to pregnant patients, who face limited pharmacological options for migraine treatment.

“The nerve in our heads that helps create this cascading series of events that becomes a migraine attack is the trigeminal nerve,” said Dehlin, who recommends the use of e-TNS devices to treat migraine.

Exercise and Movement

Research supports exercise and movement as a prophylactic treatment for migraines. The results of studies published in The Journal of Headache and Pain revealed that aerobic exercise led to a decrease in both the pain intensity and duration of migraine attacks among participants, and one study found that an aerobic exercise regimen was associated with a significant decrease in the use of acute migraine medications.

Another study recommended aerobic exercises, specifically cycling and walking, over other forms of exercise like strength training, which may have the reverse effect of exacerbating a migraine attack.  

Supplements

A 2015 study in The Journal of Headache and Pain found that supplements containing magnesium, vitamin B2 or riboflavin, and coenzyme Q10 all helped to reduce the pain and burden of migraine attacks, and linked their efficacy to deficits of those nutrients in migraine patients.

Mauskop said that he sees the most dramatic improvements in his migraine patients who take magnesium supplements, which may eliminate migraine completely in some cases.

“Magnesium is the most common deficiency—close to 50 percent of people with migraines suffer from that,” he said. He said he prescribes a dosage of 400 milligrams of magnesium glycinate to his patients. He advised against magnesium citrate, which is absorbed less well by the body.

Mauskop added that taking magnesium can also address other symptoms of magnesium deficiency, including cold hands and feet, heart palpitations, brain fog, premenstrual syndrome, and muscle cramps.    

Jill Dehlin, RN, chairperson of the National Headache Foundation’s Patient Leadership Council, recommends ginger supplements to treat the nausea that often accompanies migraine attacks. A 2014 study showed a statistically comparable efficacy in alleviating nausea between ginger powder and the acute migraine medication sumatriptan. Patients who took ginger powder reported nausea relief after two hours, with fewer clinical adverse effects than the sumatriptan.

Nutrition

There is evidence to support that omega-3 fatty acids can improve the symptoms of migraine. According to a 2021 study published in The BMJ, a diet higher in fatty fish or fatty fish oils and lower in vegetable oils reduced both the frequency and severity of migraine attacks in participants.

Monteith said that when it comes to nutrition, screening patients for potential dietary triggers is key. A 2020 study about migraine and diet identified “chocolate, citrus fruits, nuts, ice cream, tomatoes, onions, dairy products, alcoholic beverages, coffee, caffeine, monosodium glutamate (MSG), histamine, tyramine, phenylethylamine, nitrites, aspartame, sucralose, and gluten” as common migraine triggers. Monteith said skipping meals may also be a migraine trigger for some patients and emphasized the importance of eating regularly.