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MIGRAINE HEADACHE -- Alternative treatments and Conventional Medications of uncertain utility

Timothy C. Hain, MD, Chicago IL. Page last modified: January 21, 2017

Introduction:

There are an immense number of procedures, nostrums, and activities that are claimed to modify migraine.

This page contains Dr. Hain's unabashed recommendations on these alternative approaches.

Also see -- at the bottom of this page, a list of medications that are simply of uncertain use, as well as "nutritional supplements for migraine".

Alternative Treatments Arranged alphabetically.

Acupuncture: Works in about 40% of headaches, for uncertain reasons. Usually must be repeated on a weekly basis. (Schiapparelli, Allais et al. 2011). We think that even more frequent would be better, but this can be expensive as insurance usually doesn't cover acupuncture. Not recommended (because of expense).

Avoidance of certain drugs: Certain medications and recreational drugs cause headaches. For example, many cold capsules increase blood pressure. Alcohol commonly causes headache. ED drugs cause increased blood flow and can trigger migraine. Caffeine in large amounts can be a problem (see end of this section). Read the PDR or ask your doctor. Avoidance is highly recommended when practical.

Biofeedback: Used for headaches with a tension component. Not worth the expense.

cefaly

Cefaly -- this is a TENS unit recently FDA approved for migraine. The illustration above is from the cefaly web site. We have not had a single patient benefit from this device. It can be obtained with a prescription for $295. There are cheaper TENS units that are not as "cool" looking. A review of this device can be found here. More about TENS for migraine is here. Not recommended.

 

Cannabis (Marijuana) for migraine.

Little has been written about Cannabis for migraine. As of 2016, only 32 papers were found in an online "Pubmed" search, most of which were general articles. Benbadis et al (2014) suggested that "lower level clinical evidence" suggests that canabinoids may be useful for ... migraine. McGeeney (2013) pointed out that there is a very long history of the use of cannabis as a migraine abortive. One would think that the anti-nausea effects could be helpful. In Illinois where the author of this page practices medicine, medical marijuana programs are now operating, but the utility of this availability for migraine remains uncertain. We hope that studies are performed. It is unclear right now where cannabis fits into migraine management.

Chiropractic treatment: Not recommended because manipulation of the neck (specifically "snapping") may lead to stroke. Nevertheless, some patients report successful reduction in migraines through chiropractic.

Coenzyme-Q. This vitamin (100 mg three times/day) was compared in a randomized double-blind trial and found to be well tolerated for reducing attack frequency, headache-days, and days with nausea. (Standor et al, 2005). The effect was strongest for attack frequency and nausea days. Overall, seems worth a try. However, we have not been very impressed in our large headache practice, as patients usually try it for a month and then stop. Also see (Schiapparelli, Allais et al. 2010). Not recommended

Daith Piercing. This involves piercing of the outer ear, with the intention of stimulating a pressure point. We don't have an opinion about this. It is good that it can be taken out. It is bad that it involves altering a body part. There is no good reason for it to work, but that can also be said for a variety of other procedures, such as occipital nerve blocks, that seem to work at least part of the time. Not sure

Diet: Highly recommended. Foods may provoke migraine, and your doctor may advise a trial of selected food withdrawal. See list of foods which may provoke migraine.

Drugs available in foreign countries. Flunarizine, a calcium channel and dopamine blocker, is used extensively for migraine in Europe. It can be obtained legally through the mail, with an appropriate prescription. The usual dose is 5-15 mg daily. There is an immense literature about Flunarizine, and it seems pretty clear that it is effective. The calcium channel effect is probably not the important one -- dopamine blocking is probably the reason it works (see commentary at bottom of this web page).

Heat or Cold: Recommended. Some headaches, such as tension and sometimes sinus, benefit from heat to the head, such as from a hot shower. Others, usually including Migraine, get worse with heat but may respond to cold packs. Might be worth a cautious try. Don't burn yourself !

Herbal Medicines: Unsure. All herbals are categorized by the FDA as having insufficient data to ensure safety and efficacy.

Butterbur. While there were several papers published indicating that butterbur is useful in migraine, allergy and migraine associated vertigo, we don't find it effective at all in our patients. This differs from recommendations of those who generally favor alternative medication, e.g (Schiapparelli, Allais et al. 2010; Holland et al, 2012). There may some harm as well, as it may be carcinogenic. There is also no real benefit. It appears to us that the studies of this drug were mainly funded by the drug maker. Not recommended

Caffeine-containing herbs. Used for migraine to cause vasoconstriction. We see no point in using a herbal preparation for this purpose when there are better standardized preparations. Not recommended

Feverfew (Tanacetum parthenium, Chrysanthemum parthenium) is advocated to prevent migraine. We are currently not sure. It contains Parthenolide, a plant-related chemical. Legally, feverfew is a dietary supplement, because it was "grandfathered" into the US regulatory system. Average daily dose is 125 mg of dried leaves. Mouth ulceration occurs in roughly 10% of users of the leaf. This is attributed to contact dermatitis. Feverfew is also available as a capsule, which should not have this problem. Feverfew prolongs the bleeding time. Feverfew interacts with both the NSAIDS and steroids and patients on anticoagulants must be monitored closely. Contraindications include pregnancy and breast feeding. There is no information about the risks of long term use. Feverfew was not found effective in a Cochrane review (Schiapparelli, Allais et al. 2010).

On the other hand, the purified feverfew seems to have less side effects, and a recent review suggested that it might be effective (Holland et al, 2012). We think the jury is still out and are dubious that it works. None of our many migraine patients here in Chicago have come back and told us that it works. Not recommended

Lavender (lavandula angustifolia) used as extract, absorbed through the skin. Evening primrose oil (Oenothera biennis) also anecdotal evidence that it alleviates headache. Placebo

St. Johns wort (Hypericum perforatum). Used mainly as an antidepressant but a common component of herbal headache preparations. May interact with SSRI's, meperidine, dextromethorphan, tyramine-containing foods, sympathomimetic amines and trazodone. Can cause photodermatitis, orthostatic hypotension and serotonin syndrome. We don't see why someone would take this drug instead of (say) fluoxetine.

Salix alba (White willow bark) is used to treat mild headache. Similar to aspirin in side effects . It is estimated that 1-5 Liters of white willow bark tea must be consumed daily to achieve therapeutic effects (in other words, it isn't very potent). Large amounts of intake has been associated with liver toxicity. Not recommended.

Histamine (subcutaneous). Bizarrely enough, this treatment was reported as "probably effective" for migraine by Holland et al (2012), who authored an "evidence based review" . We are very dubious that a substance that breaks down in 5 minutes could modify migraine. Placebo

Ketamine nasal spray. Afridi et al (2013) recently reported that intransal ketamine reduces aura severity in patients with prolonged aura. As Ketamine is an animal tranquilizer, similar to the drug PCP, and half of the recipients reported feelings of "unreality, euphoria or mild giddiness", it would seem that doses sufficient to reduce migraine are also accompanied by some interesting side effects. Dangerous

Magnesium is a dietary supplements that are reported to reduce migraine. Magnesium is usually taken as a combination calcium/magnesium supplement. We often recommend magnesium for migraine headache in our practice in Chicago Illinois, generally in the form of a combination calcium/magnesium supplement, as is available over the counter. We suggest 500 mg/day. (Holland et al. 2012). We often have patients report that it helps. Recommended.

Homeopathic: Homeopathy in the strict sense, using very tiny amounts of herbal substances, is certainly a placebo. There is nothing wrong with placebo treatment, and if it works -- great !

Massage: Recommended. Especially useful for tension headache. Massage of the temples may be helpful. However, we advise against compression of the arteries in the neck, as this may be dangerous !

Oxygen (10 min, about 7 L/m). This is not really an alternative treatment -- it is a conventional though little used approach for a migraine variant -- cluster headache. Recommended for cluster headache.

Physical Therapy for neck pain and headaches : Recommended after medical clearance (basically a reviewed neck X-ray). Useful for headaches due to arthritis in the neck. Not recommended if there is significant disk disease or unstable neck.

Relaxation and sleep:Migraines are typically triggered by stress, and relieved by sleep. Oversleep may also trigger migraine. Stimulants (like caffeine) help headache in the short term, but may increase headache in the long term by disturbing sleep. Relaxation techniques and careful assessment of sleeping habits is highly recommended. Relaxation techniques such as used in TM are often helpful. Highly recommended.

Riboflavin (vitamin B2). It has been reported that riboflavin taken in a dose of 400 mg/day was effective in improving migraine by at least 50% in 59% of 55 patients with predominantly common migraine (Schoenen et al, 1998). The therapeutic "gain" over placebo was 37% for attack frequency.  Others suggest that it works too (Schiapparelli, Allais et al. 2010). Adverse effects were rare. This is an extremely high dose, 200 times higher than the RDA. While generally thought to be safe, this safety of this particular dose has not been well established. At this writing (2007), Riboflavin is rarely used for treatment of migraine, so this approach probably doesn't work. Overall, the ordinary dose may be worth a try. We have not had ANY patients improve from this. We think Riboflavin for migraine is a placebo.

TENS -- transcutaneous nerve stimulation. Similar in effectiveness to acupuncture, and Botox, a "supraorbital transcutaneous stimulator" has been reported to be modestly effective for migraine prevention (Schoenen et al, 2013). TENS units are available at much lower cost than Botox or acupuncture. See material above concerning the "cefaly" device, which is a TENS unit that looks very cool. Overall, we don't think the benefit is worth the trouble in terms of gadgetry and time. Not recommended.

REFERENCES for alternative treatments of migraine:

 

MEDICATIONS FOR MIGRAINE OF UNCERTAIN UTILITY

Bromocriptine. This dopamine agonist (i.e. agent that might be used to treat Parkinson's disease) was reported effective in reducing the frequency of menstrual migraine attacks when given daily (Herzog, 1997). This medication is not commonly used for this purpose, and in fact, the logic here is opposite of that below (see dopamine blockers). Not recommended.

Dopamine blockers: Haloperidol (Haldol), Prochlorperazine (Compazine), Domperidone, Chlorpromazine, Flunarizine, Metoclopramide have all been reported helpful for migraine (See Perotka article in reference list). These drugs would seem far more likely than many of the others above to produce significant side-effects. They are not used frequently, but Reglan (metoclopramide) and Promethazine have been gaining ground in emergency room treatment. Recommended in refractory situations.

Helicobacter Pylori eradication. It has been reported that eradication of this bacteria from the stomach will improve 20% of Migraine sufferers who test positive for Helicobacter (Gasbarrini et al, 1998). Whether this will be borne out is unclear. We are very dubious.

References for uncertain treatments of migraine:

 

Copyright January 21, 2017 , Timothy C. Hain, M.D. All rights reserved. Last saved on January 21, 2017