Migraine sufferers have treatment choices – neurologist explains options beyond pain medication

Migraines currently affect more than one billion people worldwide and are the second leading cause of disability worldwide.

Nearly a quarter of American households have at least one member who suffers from migraine. It is estimated that 85.6 million working days are lost each year due to migraines.

Yet many migraine sufferers consider their pain to be just a headache.

Rather than seeing a doctor, the condition often goes undiagnosed, even when other disabling symptoms occur alongside the pain, including sensitivity to light and sound, nauseavomiting and dizziness.

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Researchers have found that genetics and environmental factors play a role in the state of migraine.

They occur when changes in your brainstem activate the trigeminal nerve, which is a major nerve in the pain pathway.

This tricks your body into releasing inflammatory substances like CGRP, short for calcitonin gene-related peptide. This molecule, and others, can cause blood vessels to swell, producing pain and inflammation.

For some, drugs have their limits

A migraine can be disabling. Those who experience it are often curled up in a dark room accompanied only by their pain.

Attacks can last for days; life is put on hold. Sensitivity to light and sound, coupled with the unpredictability of the disease, causes many people to forego work, school, social gatherings, and family time.

Many prescription medications are available for migraine prevention and treatment. But for many people, conventional treatment has its limits.

Some migraine sufferers have poor tolerance to certain medications. Many cannot afford the high cost of the drugs or bear the side effects. Others are pregnant or breastfeeding and cannot take the medication.

Studies show that physical therapy with medication was superior in reducing migraine frequency, pain intensity, and pain perception compared to medication alone. (Source: Getty Images/Thinkstock)

However, as a board-certified neurologist specializing in headache medicine, I am always amazed at how open-minded and enthusiastic patients become when I discuss alternative options.

These approaches, collectively, are called complementary and alternative medicine. It might come as a surprise that a traditionally trained Western doctor like myself would recommend things like yoga, acupuncture or meditation for migraine sufferers. Yet, in my practice, I appreciate these non-traditional treatments.

Research shows that alternative therapies are associated with better sleep, better emotional feel, and an increased sense of control.

Some patients may avoid prescription drugs altogether with one or more complementary treatments. For others, non-traditional treatments can be used along with prescription drugs.

These options can be used one at a time or in combination, depending on the severity of the headache and the underlying cause.

If neck tension is contributing to pain, then physical therapy or massage may be most beneficial.

If stress is a trigger, maybe meditation would be a good place to start. It’s worth talking to your provider to explore which options are best for you.

Mindfulness, meditation and more

Because stress is a major migraine trigger, one of the most effective alternative therapies is mindfulness meditation, which is the act of focusing your attention on the present moment in a non-judgmental state of mind.

Studies show that mindfulness meditation can reduce the frequency of headaches and the intensity of pain.

Another useful tool is biofeedback, which allows a person to see their vital signs in real time and then learn how to stabilize them.

For example, if you are stressed, you may notice muscle tension, sweating, and rapid heart rate.

With biofeedback, these changes appear on a monitor and a therapist teaches you exercises to help you manage them. There is strong evidence that biofeedback can reduce the frequency and severity of migraines and reduce headache-related disability.

Yoga derives from traditional Indian philosophy and combines physical postures, meditation and breathing exercises with the aim of uniting mind, body and spirit.

Practicing yoga regularly can be helpful in reducing stress and treat migraine.

manipulation-based therapy

Physiotherapy uses manual techniques such as myofascial and trigger point release, passive stretching, and cervical traction, which is gentle pulling on the head by an expert hand or with a medical device.

Studies show that physical therapy with medication was superior in reducing migraine frequency, pain intensity, and pain perception compared to medication alone.

By reducing stress levels and promoting relaxation, massage can decrease the frequency of migraines and improve sleep. It can also reduce stress in the days following the massage, which adds extra protection against migraine attacks.

Some patients are helped by acupuncture, a form of traditional Chinese medicine.

migraine The Food and Drug Administration has approved several neuro-stimulation devices for the treatment of migraine. (Source: Getty Images/Thinkstock)

In this practice, fine needles are placed at specific locations on the skin to promote healing.

A large meta-analysis paper from 2016 found that acupuncture reduced the duration and frequency of migraine headaches, regardless of frequency. The benefits of acupuncture are maintained after 20 weeks of treatment.

What is also fascinating is that acupuncture can change the metabolic activity in the thalamus, the region of the brain essential for the perception of pain. This change was correlated with a decrease in headache intensity score after acupuncture treatment.

Vitamins, Supplements, and Nutraceuticals Herbal supplements and nutraceuticals, which are food-derived products that may have therapeutic benefits, can also be used to prevent migraine.

And there’s evidence to suggest vitamins work reasonably well compared to traditional prescription drugs. They also have fewer side effects. Here are some examples: –

Magnesium is thought to help regulate blood vessels and electrical activity in the brain. One study found that patients given 600 milligrams of magnesium citrate daily for 12 weeks had a 40% decrease in migraine. Side effects included diarrhea in nearly 20% of patients.

— Vitamin B2, or riboflavin, is also considered useful in the prevention of migraine.

When dosed at 400 milligrams daily for 12 weeks, researchers found that it halved the frequency of migraine headaches in more than half of the participants.

— Another beneficial supplement is coenzyme Q10, which is involved in the production of cellular energy.

After three months, about half of those who took 100 milligrams of coenzyme Q10 three times a day had half as many migraine attacks.

— A potential natural solution is feverfew or Tanacetum parthenium, a daisy-like perennial known for its anti-migraine properties. Taken three times a day, feverfew reduced migraine frequency by 40%.

Devices can be beneficial

The Food and Drug Administration has approved several neuro-stimulation devices for the treatment of migraine. These devices work by neutralizing the pain signals sent by the brain.

One is the Nerivio device, which is worn on the upper arm and sends signals to the brainstem pain center for a offensive. Two-thirds of people report pain relief after two hours, and side effects are rare.

Another promising device is the Cefaly. It delivers a mild electrical current to the trigeminal nerve on the forehead, which can reduce the frequency and intensity of migraine attacks.

After one hour of treatment, patients experienced an almost 60% reduction in pain intensity and relief lasted up to 24 hours. Side effects are rare and include drowsiness or skin irritation.

These alternative therapies make it possible to treat the person as a whole. In my practice, many success stories come to mind: the student who once suffered from chronic migraine but now has rare occurrences after a vitamin regimen; the pregnant woman who avoided drugs through acupuncture and physiotherapy; or the patient, already on many prescription medications, who uses a migraine neuro-stimulation device instead of adding another prescription.

Admittedly, alternative approaches are not necessarily miracle therapies, but their potential for relieving pain and suffering is remarkable. As a physician, it is truly gratifying to see some of my patients respond to these treatments.

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About Antoine L. Cassell

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