Migraines currently affect more than one billion people worldwide and are the second cause of disability in the world. Nearly a quarter of American households have at least a member who suffers from migraines. About 85.6 million working days are lost to migraines each year.
Yet many migraine sufferers consider their pain to be just a headache. Rather than seeking medical care, the condition often is not diagnosedeven when other disabling symptoms occur alongside the pain, including sensitivity to light and sound, nausea, vomiting, and dizziness.
Researchers have found that genetics and environmental factors play a role in the state of migraine. They happen when changes in your brainstem activate the trigeminal nerve, which is a major nerve in the pain pathway. This prompts your body to release inflammatory substances such as CGRP, short for calcitonin gene-related peptide. This molecule, and others, can cause blood vessels to swell, producing pain and inflammation.
For some, drugs have their limits
A migraine can be disabling. Those who experience it are often curled up in a dark room accompanied only by their pain. Attacks can last for days; life is put on hold. Sensitivity to light and sound, coupled with the unpredictability of the disease, causes many people to forego work, school, social gatherings, and family time.
Many prescription medications are available for the prevention and treatment of migraine. But for many people, conventional treatment has its limits. Some migraine sufferers have a low tolerance to certain medications. Many cannot afford the high cost of the drugs or bear the side effects. Others are pregnant or breastfeeding and cannot take the medication.
However, as graduate neurologist who specializes in headache medicine, I am always amazed at how open-minded and enthusiastic patients become when I discuss alternative options.
These approaches, collectively, are called complementary and alternative medicine. It might come as a surprise that a traditionally trained Western doctor like myself would recommend things like yoga, acupuncture, or meditation for migraine sufferers. However, in my practice, I appreciate these non-traditional treatments.
Research shows that alternative therapies are associated with better sleep, better emotional feeling, and an increased sense of control. Some patients may avoid prescription drugs altogether with one or more complementary treatments. For others, non-traditional treatments can be used along with prescription drugs.
These options can be used one at a time or in combination, depending on the severity of the headache and the underlying cause. If neck tension is contributing to the pain, physical therapy or massage may be most beneficial. If stress is a trigger, maybe meditation would be a good place to start. It’s worth talking to your provider to explore which options are best for you.
Mindfulness, meditation and more
Because stress is a major migraine triggerone of the most effective alternative therapies is mindfulness meditation, which is the act of focusing your attention on the present moment in a non-judgmental state of mind. Studies show that mindfulness meditation can reduce headache frequency and pain intensity.
Another useful tool is biofeedbackwhich allows a person to see their vital signs in real time and then learn how to stabilize them.
For example, if you are stressed, you may notice muscle tension, sweating, and a racing heart rate. With biofeedback, these changes appear on a monitor and a therapist teaches you exercises to help you manage them. There is strong evidence that biofeedback can decrease the frequency and severity of migraines and reduce headache-related disability.
Yoga derives from traditional Indian philosophy and combines physical postures, meditation and breathing exercises with the aim of uniting mind, body and spirit. Practice yoga regularly can be useful in the reduction of stress and the treatment of migraine.
physical therapy uses manual techniques such as myofascial release and trigger-point, passive stretching and cervical traction, which is a slight pull on the head by an expert hand or with a medical device. Studies show that physiotherapy with medication was superior in reducing migraine frequency, pain intensity and pain perception compared to medication alone.
By reducing stress levels and promoting relaxation, massage can reduce the frequency of migraines and improve sleep. It can also reduce stress in the days following the massage, which adds extra protection against migraine attacks.
Some patients are helped by acupuncture, a form of traditional Chinese medicine. In this practice, fine needles are placed at specific locations on the skin to promote healing. A large meta-analysis paper from 2016 found acupuncture reduces the duration and frequency of migraines whatever their frequency. Benefits of acupuncture are maintained after 20 weeks of treatment.
What is also fascinating is that acupuncture can alter metabolic activity in the thalamus, the region of the brain essential for the perception of pain. This change was correlated with a decrease in headache intensity score after acupuncture treatment.
Vitamins, supplements and nutraceuticals
herbal supplements and nutraceuticals, which are food products that can have a therapeutic effect, can also be used to prevent migraine. And there is evidence to suggest that vitamins work reasonably well compared to traditional prescription drugs. They also have fewer side effects. Here are some examples:
Devices can be beneficial
The Food and Drug Administration has approved several neurostimulation devices for the treatment of migraine. These devices work by neutralizing the pain signals sent by the brain.
One is the Nerivio device, which is worn on the upper arm and sends signals to the brainstem pain center during an attack. Two-thirds of people report pain relief after two hours, and side effects are rare.
Another promising device is the Cefaly. It delivers a slight electric current to the trigeminal nerve on the forehead, which can decrease the frequency and intensity of migraine attacks. After one hour of treatment, patients experienced an almost 60% reduction in pain intensity and relief lasted up to 24 hours. Side effects are rare and include drowsiness or skin irritation.
These alternative therapies make it possible to treat the person as a whole. In my practice alone, many success stories come to mind: the student who once had chronic migraine but now has rare occurrences after vitamin regimen; the pregnant woman who avoided drugs through acupuncture and physiotherapy; or the patient, already on numerous prescription medications, who uses a migraine neurostimulation device instead of adding another prescription.
Admittedly, alternative approaches are not necessarily miracle therapies, but their potential for relieving pain and suffering is remarkable. As a physician, it is truly gratifying to see some of my patients respond to these treatments.