Nutraceutical, biobehavioral, and physical treatments, including complementary and alternative medicines, may benefit patients with migraine and other headache disorders. This article summarizes the evidence for the use of these therapies with discussion on evidence quality and product controversies.
The evidence for the use of nutraceuticals is low or conflicting. For migraine prevention in adults, Level B evidence, at best, exists for the use of feverfew, magnesium, and riboflavin (vitamin B2). Level C evidence exists for coenzyme Q10 (CoQ10) and Level U evidence for melatonin. While Level A evidence exists for the use of Petasites, caution should be exercised given the potential for hepatic toxicity. The evidence level for IV magnesium for acute migraine treatment is B or U, depending on the interpretation of the existing literature. The evidence level for adding biobehavioral adjunctive treatment for headache management is A. The evidence level for exercise in reducing migraine is B-C.
Strong evidence supports behavioral therapy as adjunctive treatment for migraine prevention. Modest evidence exists for exercise and a variety of nutraceuticals for migraine prevention in adults and IV magnesium for acute migraine therapy. In children and adolescents, the evidence is low for all nutraceuticals. Petasites has been associated with hepatic toxicity, and caution should be exercised regarding its use.
Address correspondence to Dr Stewart J. Tepper, Cleveland Clinic, Headache Center, C21, 9500 Euclid Avenue, Cleveland, OH 44195, email@example.com.
Relationship Disclosure: Dr Tepper has served as a consultant for Acorda Therapeutics Inc; Amgen Inc; ATI Pharma; Avanir Pharmaceuticals, Inc; Civitas Therapeutics; Depomed, Inc; electroCore LLC; Impax Laboratories, Inc; Pfizer Inc; Teva Pharmaceutical Industries Ltd; and Zogenix, Inc. Dr Tepper has received personal compensation for speaking engagements from Allergan, Inc; Depomed, Inc; Impax Laboratories, Inc; Nautilus Neurosciences; Teva Pharmaceutical Industries Ltd; and Zogenix, Inc. Dr Tepper serves on the board of directors of the North Central Headache Society and the advisory boards of Amgen Inc, Dr. Reddy’s Laboratories, Eli Lilly and Company, and Teva Pharmaceutical Industries Ltd. Dr Tepper receives personal compensation for manuscript preparation from the American Headache Society and development of educational presentations from Depomed, Inc; Pfizer Inc; and Teva Pharmaceutical Industries Ltd. Dr Tepper receives personal compensation from the American Headache Society for serving as an associate editor for Headache Currents and royalties from Cambridge University Press, People’s Publishing House, Springer Science + Business Media, and University Press of Mississippi. Dr Tepper owns stock or stock options in ATI Pharma. Dr Tepper’s wife receives personal compensation from the American Headache Society for writing a column for the journal Headache and royalties from Springer Publishing Company.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Tepper discusses the unlabeled/investigational use of nutraceuticals for the treatment of headaches, none of which are approved by the US Food and Drug Administration.