There’s no treatment for migraine that’s 100% effective, and lots of reasons why some people may be unable or unwilling to use some treatments (for example, side effects or drug interactions).
Fortunately, there are a variety of evidence-based options for non-drug migraine treatment that provide alternatives, but the evidence is stronger for some treatments than others.
1. Dietary supplements
Riboflavin (vitamin B2) supports energy production in the body’s cells. Daily intake of 400 mg of riboflavin is recommended for migraine prevention by expert organisations in Europe and North America, despite limited evidence.
Coenzyme Q10 also supports cellular energy production, as well as helping blood vessel function and reducing inflammation.
100 mg of Coenzyme Q10, taken three times daily, is recommended by expert groups even though the evidence is low quality.
Magnesium has a variety of actions by which it may prevent migraine. A daily dosage of 600mg of magnesium citrate is supported by some evidence of benefit and minimal side effects.
Butterbur and feverfew are herbs that have been studied for the prevention of migraine but liver damage from butterbur has been reported and there are concerns about the strength of the evidence for the benefit of feverfew.
In summary, evidence that these dietary supplements can effectively prevent migraine is limited.
As for any supplement, you should talk to your doctor about taking it before starting, to make sure that it is safe for you.
2. Neuromodulation
This form of treatment involves the use of magnetic or electrical stimulation of nerves in the brain or other parts of the body, which ultimately reduces pain.
Neuromodulation is non-invasive, in that the nerve stimulation is delivered across the skin by hand-held magnets or electrodes placed on the skin.
Non-invasive neuromodulation provided short-term (two-hour) pain relief from migraine headache, according to a systematic review and meta-analysis, but longer-term (24-48-hour) pain was not reduced.
Non-invasive neuromodulation may be useful for the prevention of migraine attacks, according to the results of early clinical trials, but more evidence is needed from ongoing studies.
Invasive nerve stimulation, which involves surgical placement of stimulation devices or implantation of wires, has had mixed success in migraine treatment and prevention.
These devices are still in the research stage.
3. Acupuncture
A recent systematic review of randomised controlled trials of acupuncture for the treatment of migraine found it to be safe and effective.
Acupuncture was as effective as medication in some studies, with lasting effect, less use of pain medication and a reduction in the number of migraine attacks.
4. Behavioural techniques
Relaxation techniques, cognitive behavioural therapy and biofeedback devices can help people cope with migraine symptoms, either in combination with medication or as stand-alone management options.
5. Spinal manipulation
The evidence to support spinal manipulation for the treatment of migraine is limited, and further clinical trials are required to determine whether migraine pain/intensity and the number of migraine days is reduced.
Differences in how spinal manipulation is performed by different practitioners “makes it difficult to determine the magnitude of this effect”.
6. Botulinum toxin
Botox injections in the head and neck prevent nerve transmission to muscles, thereby causing muscle relaxation and potentially reducing pain.
For people with chronic migraine (more than 15 migraine headache days per month), botox injections reduce the number of migraine days by two per month on average, but there is not enough evidence to support the use of botox in people who get migraines less often.
7. Aerobic exercise
There is moderate to low quality evidence that aerobic exercise can reduce the occurrence of migraine attacks, their duration and intensity.
These alternatives to medication for treatment and prevention of migraine might suit you, but you should consult your doctor before starting or making changes to treatment for migraine.
