In an effort to establish greater clarity on the value of complementary and integrative medicine (CIM) for integration into conventional headache management, a team of researchers from the Mayo Clinic in Scottsdale, Arizona, and Rochester, Minneapolis, performed a literature review of popular complementary and alternative therapies and practices for headache relief.1 They concluded that several CIM methods bring value and that their integration into a headache management plan in the clinical setting empowers patients’ healing process.
Although conventional over-the-counter and prescription medications offer relief for most headache sufferers, an increasing number of patients are looking to CIM for relief of acute, chronic, or recurrent headache. One study found that 50% of US adults with migraines or severe headaches have used at least 1 type of CIM within the past 12 months and are more likely to use CIM than adults who do not experience severe headaches.2
The growing use of CIM for headache is spurring research, which indicates that some treatments and practices may represent effective adjuncts to conventional care.3
Commonly used CIM for headache management includes massage therapy, acupuncture, mind-body medicine (eg, biofeedback, guided meditation), and the use of botanicals and supplements. Through their literature review, based on 5 meta-analyses, 7 systematic reviews, and 34 randomized controlled trials (RCTs), the Mayo Clinic team, headed by Denise Millstine, MD, an internist affiliated with the integrative medicine section in the department of general internal medicine at the Mayo Clinic in Scottsdale, found evidence for the value of acupuncture, yoga, tai chi, biofeedback, and guided meditation. Manual therapies (massage and osteopathic techniques) also showed some efficacy, but the efficacy of a number of popular supplements was less clear.
Needles and Pins
The literature review showed that acupuncture reduces the frequency of several types of acute headaches and has similar efficacy to some prophylactic drugs. The researchers noted, however, that some studies also have shown that patients who expect to achieve a good result from acupuncture for headache relief are more likely to have a favorable response than patients who have no expectations (P =.002). However, studies that compared structured physical activity intervention with acupuncture showed that physical activity was superior to acupuncture for headache relief.
Both tai chi and yoga showed benefit. Limited benefit was observed with massage therapy, with headache-related symptoms temporarily alleviated either soon after a session or several weeks after the massage therapy. RCTs on positional release therapy – a type of manual therapy in which muscles are positioned to take tension off neuromusculature – and osteopathic manipulative therapy both showed promise in alleviating symptoms of migraine. Biofeedback and guided imagery, but not mindfulness meditation, also helped reduce headache intensity and duration in several RCTs.
Vitamins and Supplements
Review of studies on vitamins and supplements commonly used for the relief of headaches found some value in remedies such as lavender oil aromatherapy and citron syrup. The value of folic acid, vitamins B6 and B12, feverfew, and omega 3 fatty acids remains unclear, and the use of the herb butterbur is discouraged, as it has been associated with severe hepatotoxicity. “Use of over-the-counter supplements among patients with headache is prevalent, so I urge primary care providers to be familiar with those for which there is evidence of effect without harm,” Dr Millstine told Clinical Pain Advisor.
“Most patients with headache can benefit from integrative medicine modalities, particularly if there is an element of stress relating to their symptoms, “ Dr Millstine said. “We often use acupuncture in patients with migraine and gentle yoga in patients with any primary headache.”
Summary and Clinical Applicability
CIM therapies and practices are widely used by migraineurs and others with chronic or recurrent headache. Research suggests that some of these modalities have value. Thus, healthcare providers should consider familiarizing themselves with popular CIM therapies and practices and discuss their inclusion in the overall headache management strategy.
Low to moderate quality evidence exists for the effectiveness of a number of CIM therapies in the management of primary headache.
- Millstine D, Chen CY, Bauer B. Complementary and integrative medicine in the management of headache. BMJ. 2017 May 16;357:j1805.
- Wells RE, Bertisch SM, Buettner C, et al. Complementary and alternative medicine use among adults with migraines/severe headaches. Headache. 2011;51(7):1087-1097.
- National Center for Complementary and Integrative Health. Complementary health approaches for chronic pain: what the science says. https://nccih.nih.gov/health/providers/digest/chronic-pain-science. September 2016. Accessed August 5, 2017.