Migraine Overview

Migraines are a prevalent condition affecting approximately 50% of men and 20% of women at some point in their lives. Many oral medications used to treat migraines can produce undesirable side effects and may not be as effective as anticipated. A review published in *Neurotherapeutics* explores several alternative treatments and techniques for managing migraine headaches.

Alternative Treatments for Migraines

Nutraceuticals

Nutraceuticals refer to food or dietary supplements that offer health or medicinal advantages. Key nutraceuticals that have demonstrated some efficacy in preventing migraines include vitamin B2 (riboflavin), coenzyme Q10, magnesium, butterbur root extract (Petasites hybridus), and feverfew (Tanacetum parthenium). Clinical studies indicate that both vitamin B2 and coenzyme Q10 may help decrease the frequency of migraine attacks. Currently, only vitamin B2 is recommended as a low-risk preventive option for migraines, while the others show mixed results, indicating a need for further investigation. Notably, butterbur extract is not advised due to safety concerns regarding liver toxicity.

Behavioural Therapy

Behavioural therapies, including relaxation techniques, biofeedback training, and cognitive behavioural therapy, are also employed in migraine treatment. These methods focus on helping patients identify migraine triggers and manage their symptoms more effectively. Clinical studies suggest that when these therapies are combined with medication, they yield better results in reducing headache frequency compared to medication alone. Furthermore, patients may find they can lower their medication dosage for migraines.

Neuromodulation

A novel treatment approach known as non-invasive neuromodulation involves stimulating nerves to alleviate migraine-related pain. This method utilizes devices that deliver magnetic or electrical pulses through the skin to target brain nerves. Among the various nerve stimulation techniques, single-pulse transcranial magnetic nerve stimulation and transcutaneous cranial nerve stimulation show significant potential in reducing the frequency and intensity of migraines. However, access to these treatments is currently limited to specialized centers.

Conclusion

The authors of the review conclude that the landscape of non-pharmaceutical migraine treatments is rapidly evolving. They encourage clinicians to explore these alternative options for patients who are hesitant to use pharmacological treatments or who present with complex cases. Neuromodulation, nutraceuticals, and behavioural therapy all offer promising evidence of effectiveness with minimal side effects. To enhance migraine management and develop more personalized treatment strategies, larger-scale clinical trials are necessary.

Reference

Puledda, F., Shields, K. Non-pharmacological approaches for migraine. *Neurotherapeutics* 15, 336–345 (2018). https://doi.org/10.1007/s13311-018-0623-6