9/15/14
Interest in the use of complementary and alternative medicine (CAM) by headache patients is widespread. A 2002 survey showed that more than 85% of headache patients use CAM therapies and 60% felt they provided some relief.[113] Overall, more than 70% of patients who use CAM do not tell their doctors about it.
Some CAM techniques have good scientific evidence of benefit and have been proven by studies to be effective in preventing migraine. Biofeedback and behavioral therapy should be part of the standard of care for a difficult migraine patient.
Good studies have demonstrated the effectiveness of the herb butterbur (Petasites hybridus) in preventing migraines.[114] A guideline from the American Academy of Neurology and the American Headache Society (AAN/AHS) recommends offering butterbur to patients with migraine to reduce the frequency and severity of migraine attacks (level A recommendation).[98] Patients on butterbur require monitoring of liver enzymes.
The AAN/AHS found moderate evidence of effectiveness for riboflavin (vitamin B2), magnesium, and feverfew. A 3-month, randomized, controlled trial of high-dose riboflavin (400 mg) found that riboflavin was superior to placebo in reducing attack frequency and headache days.[115]
A randomized, controlled trial of coenzyme Q10 (CoQ10) documented that CoQ10 is effective and well tolerated for migraine prophylaxis.[116] Results of a trial in children and adolescents suggested that prophylaxis with CoQ10 may lead to earlier improvement in headache severity than does placebo-based prophylaxis, but the trial found no long-term difference in headache outcomes between the CoQ10 and placebo groups.[117]
Melatonin has also been used for migraine prevention. Alstadhaug et al conducted a randomized, controlled, 8-week trial of prolonged-release melatonin (2 mg 1 hour before bedtime) in adult patients experiencing 2-7 migraine attacks per month. Although the investigators found that in the melatonin group the average attack frequency fell from 4.2 to 2.8 per month, this result was not significantly superior statistically to the reduction seen with placebo.[111]
A variety of other CAM techniques are not bolstered by solid scientific data, but they may be perceived to be of benefit to patients.[118] Techniques that some patients use for headache relief include the following:
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Body work – Eg, chiropractic, massage, and craniosacral therapy [119] )
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Nutritional/herbal supplements – Eg, vitamins and herbs
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Yoga [120]
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Acupressure and acupuncture [121]
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Biofeedback [122, 123]
Overall, scientific evidence on the efficacy of these modalities is lacking, partly due to the poor design and/or poor quality of the studies performed to date.
Mindfulness-based stress reduction and home meditation have been studied as a method to reduce the pain and improve health-related quality of life in patients with chronic pain syndromes. While this method proved effective for chronic arthritis patients, it was not deemed effective in patients with chronic headache/migraine or fibromyalgia.[124]
The advantages of CAM therapies are that many of these remedies have no adverse effects, they advocate a self-help technique that is attractive to patients, and they offer a holistic approach. The practitioners often spend significant time with their patients, and that in itself makes the patient feel as if he or she has been given careful attention.
The disadvantages of CAM therapies include the lack of standardization of either the practice or the dispensing of the therapies and techniques. In addition, for many of these modalities, no standard format exists to ensure that practitioners are adequately trained in the techniques they use.