Complementary and Alternative Therapies
Reviewed by: HU Medical Review Board | Reviewed March 2022 | Last updated: June 2023
Unpredictability is one of the most frustrating aspects of migraine. Self-efficacy is the belief that you can make a difference in your migraines. In some cases, it might mean talking to your health care provider about your symptoms or medications. In other cases, you might be looking for things you can do on your own.
What does complementary therapy include?
Complementary therapy is a broad category of treatments. It includes many practices that are not part of conventional Western medicine. It may include supplements, natural products, and mind-body practices. Many people find that complementary therapies ease their migraine symptoms. Some therapies may also reduce the frequency of attacks.
In the 2018 Migraine In America survey, respondents were asked “What else, if anything, do you use on a regular basis to treat migraine and/or its symptoms?” Out of the 4,356 respondents, 8 out of 10 reported using alternative therapies, including taking vitamins and supplements, partaking in various forms of exercise, avoiding triggers, practicing stress relief tactics, and other alternatives such as daith piercing and CBD oil.
What are migraine triggers?
Migraine triggers are anything linked to the start of a migraine attack. Triggers are not the cause of a migraine. The causes of migraine are still not completely understood, but they probably have to do with dysfunctional nerve signaling.
Different people have different migraine triggers. A migraine journal can help you understand your personal triggers. Common triggers are:
- Weather and other environmental factors
- Stress and strong emotions
- Bright or fluorescent light
- Food and drink
- Hormone changes
- Movement and physical activity
Do triggers set off an attack or warn of one?
Trigger avoidance has long been a mantra for migraine prevention. But new information about the causes of migraine is turning this around. Changes in the brain at the start of an attack (prodromal phase) might increase sensitivity or cause cravings.1 In fact, triggers may not set off the migraine attack, they may be a warning about its onset. Knowing your triggers increases the predictability of your migraine. It can help you to manage your migraines.
Have you tried complementary/alternative treatments?
What supplements and natural products are used?
A long list of natural products has been suggested for migraine prevention. Unfortunately, many have not been formally studied in high quality trials.
In 2015, the American Headache Society retired its 2012 Guidelines regarding complementary treatments for episodic migraine.2 The primary reason was serious safety concerns about butterbur (petasites).3 Butterbur is effective for migraine prevention. However, unprocessed butterbur has chemicals called pyrrolizidine alkaloids. These chemicals can damage the liver. One study showed that one-third of butterbur supplement contained the harmful pyrrolizidine alkaloids. In the same study, only one-third of samples contained the amount of active ingredient shown on the label.
Other supplements that are probably effective for migraine prevention are riboflavin (B2), magnesium, and feverfew.4Co-enzyme Q is possibly effective for migraine.4 No serious side effects have been reported with these supplements if they are taken at recommended levels.5-8 Magnesium, feverfew, and co-enzyme Q may cause nausea, diarrhea, or digestive upset.
If you choose to use natural remedies and supplements, tell your healthcare provider. Natural products can have side effects or toxicities. Many interact with other drugs.
Which mind and body approaches are used?
Mind and body approaches can be used alone or in conjunction with medications. They can be helpful if you cannot or will not take migraine drugs. They may be useful if migraine drugs are not enough. These approaches can help to reduce stress, which has numerous health benefits.
Through biofeedback, you learn to notice and control body functions. For example, you may become aware of muscle tension and learn how to relax those areas. Biofeedback may reduce migraine frequency.9 It may help you feel some control over your migraines.
Acupuncture may have a small preventive effect.10Massage therapy is possibly helpful for migraine.11
Additional mind-body approaches include meditation, yoga, tai chi, qi gong, healing touch, and hypnotherapy. Generally speaking, there is not a strong evidence base for these therapies. Often the evidence is conflicting. However, these therapies are considered safe for most individuals if they are performed by trained professionals.
What should you discuss with your doctor?
When considering adding complementary and alternative therapies for migraine to your treatment regimen, it’s important to keep in mind that many of these approaches have not been studied for the treatment of migraine. Although many people believe that complementary and alternative therapies are safe and do not have harmful side effects, that is not always true. It’s critical to share with your doctors all the approaches you are considering using, as some complementary and alternative can reduce the effectiveness of traditional medicine or may cause other serious problems.
As always, the best source for advice on treating migraine is your own migraine specialist. These descriptions of natural remedies are provided only for informational purposes. You should begin no medication or supplement without first checking with your health care provider and should let them know of any other prescriptions, OTCs, and herbals you are taking to ensure there are no interactions.