Nonmedication, Alternative, and Complementary Treatments for Migraine

Alexander Mauskop, MD, FAAN Headache p. 796-806 August 2012, Vol.18, No.4 doi: 10.1212/01.CON.0000418643.24408.40
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Purpose of Review: The efficacy of some nonpharmacologic therapies appears to approach that of most drugs used for the prevention of migraine and tension-type headaches. These therapies often carry a very low risk of serious side effects and frequently are much less expensive than pharmacologic therapies. Considering this combination of efficacy, minimal side effects, and cost savings, medications should generally not be prescribed alone but rather in combination with nonpharmacologic therapies.

Recent Findings: In addition to the established nonpharmacologic therapies, such as biofeedback, relaxation training, butterbur, riboflavin, magnesium, and coenzyme Q10 (CoQ10) supplementation, recent data provide support for the use of aerobic exercise and acupuncture. Discovery of the high incidence of the C677T mutation of the methylenetetrahydrofolate reductase gene, MTHFR, and attendant elevation of homocysteine levels in patients with migraine with aura led to a trial of cyanocobalamin, folate, and pyridoxine in these patients. This trial showed that taking these three supplements resulted in a reduction of homocysteine levels and improvement of migraines.

Summary: Therapies proven (to various degrees) to be effective for migraine include aerobic exercise; biofeedback; other forms of relaxation training; cognitive therapies; acupuncture; and supplementation with magnesium, CoQ10, riboflavin, butterbur, feverfew, and cyanocobalamin with folate and pyridoxine.

Address correspondence to Dr Alexander Mauskop, New York Headache Center, 30 East 76th Street, New York, NY 10021,

Relationship Disclosure: Dr Mauskop has served as a speaker for Allergan, Inc.; GlaxoSmithKline; and Zogenix, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Mauskop reports no disclosure.

© 2012 American Academy of Neurology