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Migraine headaches - Non-Drug Treatments and Lifestyle Changes

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of migraine.

Non-Drug Treatments and Lifestyle Changes:

There are several ways to prevent migraine attacks. You should try a healthy diet, the right amount of sleep, and non-drug approaches (such as biofeedback) first for prevention.

Behavioral Treatments

Behavioral techniques that reduce stress and empower the patient may help some people with migraines. They generally include:

  • Biofeedback therapy
  • Relaxation techniques
  • Cognitive-behavioral therapy

Behavioral methods may help counteract the tendency for muscle contraction and uneven blood flow associated with some headaches. They may be particularly beneficial for children, adolescents, and pregnant and nursing women, and anyone who cannot take most migraine medications. Studies generally find that these techniques work best when used in combination with medications.

Biofeedback. Many studies have demonstrated that biofeedback is effective for reducing migraine headache frequency. Biofeedback training teaches the patient to monitor and modify physical responses, such as muscle tension, using special instruments for feedback.

Relaxation Therapy. Relaxation therapy techniques include relaxation response, progressive muscle relaxation, visualization, and deep breathing. Muscle relaxation techniques are simple and easy to learn, and can be effective. Some patients may also find that relaxation techniques combined with applying a cold compress to the forehead may help provide some pain relief during attacks. Some commercially available products use a pad containing a gel that cools the skin for several hours.

Cognitive Behavioral Therapy. Cognitive-behavioral therapy (CBT) teaches patients how to recognize and cope with stressors in their life. It can help patients understand how their thoughts and behavior patterns may affect their symptoms, and how to change the way the body responds to anticipated pain. CBT may be included with stress management techniques. Research indicates that CBT is most effective when combined with relaxation training or biofeedback.

Acupuncture

Acupuncture is a Chinese medicine technique that uses thin needles to stimulate specific points aligned with energy pathways in the body. Studies have showed mixed results on the benefits of acupuncture for preventing migraine.

Lifestyle Changes

Making a few minor changes in your lifestyle can make your migraines more bearable. Improving sleep habits is important for everyone, and especially those with headaches. What you eat also has a huge impact on migraines, so dietary changes can be extremely beneficial, too.

Avoid Food Triggers. Avoiding foods that trigger migraine is an important preventive measure. Common food triggers include monosodium glutamate (MSG), processed lunch meats that contain nitrates, dried fruits that contain sulfites, aged cheese, alcohol and red wine, chocolate, and caffeine. However, peopleā ' s responses to triggers differ. Keeping a headache diary that tracks diet and headache onset can help identify individual food triggers.

Eat Regularly. Eating regularly is important to prevent low blood sugar. People with migraines who fast periodically for religious reasons might consider taking preventive medications.

Stay Physically Active. Exercise is certainly helpful for relieving stress. An analysis of several studies reported that aerobic exercise in particular might help prevent migraines. It is important, however, to warm up gradually before beginning a session, since sudden, vigorous exercise might actually precipitate or aggravate a migraine attack.

Limit Estrogen-Containing Medications. Medications that contain estrogen, such as oral contraceptives and hormone replacement therapy, may trigger migraines or make them worse. Talk to your doctor about whether you should stop taking these types of medications or reduce the dosage.

Herbs and Supplements

Manufacturers of herbal remedies and dietary supplements do not need Food and Drug Administration approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been several reported cases of serious and even lethal side effects from herbal products. Patients should always check with their doctors before using any herbal remedies or dietary supplements.

Riboflavin (Vitamin B2). Some studies have found that people who take vitamin B2 experience a reduction in the frequency of migraine attacks (although not on duration or severity). Vitamin B2 is generally safe, although some people taking high doses develop diarrhea.

Magnesium Supplements. Some studies have reported a higher rate of magnesium deficiencies in some patients with migraine, such as those with menstrual migraines. Magnesium helps relax blood vessels. Some patients report that magnesium supplements help provide relief.

Feverfew. Feverfew is the most studied herbal remedy for headaches and may help in some cases. However, like all effective headache remedies, overuse can cause a rebound effect.

Fish Oil. Some studies suggest that omega-3 fatty acids, which are found in fish oil, have anti-inflammatory and nerve protecting actions. These fatty acids can be found in oily fish, such as salmon, mackerel, or sardines. They can also be obtained in supplements of specific omega-3 compounds (DHA-EPA).

Ginger. In general, herbal medicines should never be used by children or pregnant or nursing women without medical counsel. One exception may be ginger, which has no side effects and can be eaten in powder or fresh form, as long as quantities are not excessive. Some people have reported less pain and frequency of migraines while taking ginger, and children can take it without danger. Ginger is also a popular home remedy for relieving nausea.

Resources

References

Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging? JAMA. 2006 Sep 13;296(10):1274-83.

Ebell, MH.Diagnosis of migraine headache. Am Fam Physician. 2006;74(12):2087-8.

Goadsby PJ. Recent advances in the diagnosis and management of migraine. BMJ. 2006 Jan 7;332(7532):25-9.

Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S, et al. Practice parameter: pharmacological treatment of migraine headache in children and adolescents: report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology. 2004 Dec 28;63(12):2215-24.

Lewis DW, Winner P, Hershey AD, Wasiewski WW; Adolescent Migraine Steering Committee. Efficacy of zolmitriptan nasal spray in adolescent migraine. Pediatrics. 2007 Aug;120(2):390-6.

Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF; AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007 Jan 30;68(5):343-9.

Monastero R, Camarda C, Pipia C, Camarda R. Prognosis of migraine headaches in adolescents: a 10-year follow-up study. Neurology. 2006 Oct 24;67(8):1353-6.

Nestoriuc Y, Martin A. Efficacy of biofeedback for migraine: a meta-analysis. Pain. 2007 Mar;128(1-2):111-27. Epub 2006 Nov 2.

Pringsheim T, Davenport WJ, Dodick D. Acute treatment and prevention of menstrually related migraine headache: evidence-based review. Neurology. 2008 Apr 22;70(17):1555-63.

Sierpina V, Astin J, Giordano J. Mind-body therapies for headache. Am Fam Physician. 2007 Nov 15;76(10):1518-22.

Silberstein S, Tfelt-Hansen P, Dodick DW, Limmroth V, Lipton RB, Pascual J, et al. Guidelines for controlled trials of prophylactic treatment of chronic migraine in adults. Cephalalgia. 2008 May;28(5):484-95. Epub 2008 Feb 20.

Wilson, JF. In the clinic. Migraine. Ann Intern Med. 2007;147(9):ITC11-1-ITC11-16.

  • Reviewed last on: 9/9/2008
  • Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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