Yoga practice has been associated with improvements in migraine, including in one study in which 3 weekly sessions of yoga for 12 weeks led to greater reductions in headache severity, frequency, and impact when combined with medication, compared with mediation alone.6 In another study, patients who practiced yoga daily after completion of an Ayurvedic treatment program experienced greater reductions in headache intensity and quality of life compared with those who took nonsteroidal anti-inflammatory drugs for symptom relief.4

Other recent findings indicate that tai chi practice was associated with fewer migraine days (−3.6 migraine days, P <.001) compared with migraine days in a wait-list control group, and this correlated with a significant decrease in systolic blood pressure (P <.05).4

Supplements. In a 2012 guideline update from the American Headache Society and the American Academy of Neurology, it was determined that the efficacy of butterbur for migraine prevention is supported by level A evidence. “However, concerns over hepatotoxicity with butterbur resulted in these entire guidelines being retired, and new ones are now pending,” the review authors wrote.4 Feverfew, magnesium, and riboflavin were classified as having level B evidence, and coenzyme Q10 was found to have level C evidence for migraine prophylaxis.

A small number of studies suggest that several combinations of these and other compounds, including vitamin B6 and folic acid, may improve the number of migraine days, certain symptoms, and quality of life, although results are mixed.4 In other research, melatonin was found to improve migraine4 in adult and pediatric patients, and results from a randomized controlled trial indicated that ginger extract combined with intravenous ketoprofen decreased headache intensity and pain in patients presenting to the emergency department with migraine compared with in individuals who received ketoprofen plus placebo.7

Manual therapies. This category “encompasses a multitude of interventions to enhance mobilization, reduce pathologic restrictions, and provide neuromodulation via a physical treatment,” according to the review.4 Osteopathic manipulation treatment and high-velocity chiropractic manipulation have been linked with fewer migraine days. Additional studies have produced initial promising results for massage therapy and reflexology in individuals with migraine.

Exercise. A range of studies have shown beneficial effects of regular aerobic exercise on migraine, including a 2018 randomized controlled trial, in which such practices were associated with reductions in migraine frequency, duration, intensity, and disability compared with control treatments.8

Acupuncture. There is accumulating evidence that acupuncture improves migraine outcomes. For example, patients who were treated with acupuncture reported reduced headache intensity, which correlated with increased N-acetylaspartate/creatine in the bilateral thalamus on magnetic resonance spectroscopy.9 “This research showed that the biochemical effect of acupuncture may target brain regions important for pain perception (thalamus) and the effect had clinical significance on pain outcomes,” noted the review authors.4

Researchers are investigating several of these modalities in ongoing studies. “As both patients and providers become more educated on both the research-based evidence and on the most common modalities patients practice, an open dialogue can be created to ensure that patients are informed on the safest and most effective treatment options while concurrently playing an active role” in deciding which of these therapies to use.4

For additional insights regarding this topic, Clinical Pain Advisor interviewed review co-author Rebecca Erwin Wells, MD, MPH, associate professor in the department of neurology at Wake Forest and UCNS Certified Headache Specialist; and Mia Tova Minen, MD, MPH, chief of headache research and assistant professor in the departments of neurology and population health at NYU Langone Medical Center.  

Clinical Pain Advisor: What are some of the complementary and alternative medicine interventions for migraine that are best supported by research?

Dr Minen: Please note that the preferred term is now “complementary and integrative health” so that the modalities can still be paired with more “traditional” medicine. This is why the National Center for Complementary and Alternative Medicine was renamed the National Center for Complementary and Integrative Health.