Exploring non-drug treatment options for migraine

By: Ria Bhola, Headache Nurse Specialist, The Migraine Trust

15th February 2022

Non-drug treatment strategies aim to both treat an attack early and reduce the number of migraine attacks. There are many reasons why a medication treatment may not be an option for people with migraine:

  • There is a risk of overusing painkillers or the need to withdraw or reduce these medicines
  • The painkiller medicines may be contributing to the migraine attacks (medication overuse headache)
  • Medicines are simply not effective or adequately effective
  • Migraine medicines may have to be avoided due to other health conditions
  • Side effects of the medicines make them difficult to take or take at high enough doses

Non-drug options may fall into several categories:

Trigger Management – A trigger is something that happens to you, or something that you do, which seems to result in you having a migraine attack. The migraine attack may start anywhere between six hours and two days after the trigger happens.

If you have migraine, many things can be a trigger. This means it can be very difficult to identify your potential triggers. It may also be a combination of a few things that seems to lead to a migraine attack. A trigger may not lead to a migraine attack every time. We know that the brain of someone with migraine likes balance, like regular sleep and meal patterns. We also know that migraine can be triggered by alcohol and the menstrual cycle. The evidence for other triggers, such as exercise, eating chocolate and bright light, is less certain.

It can sometimes be difficult to tell if something is really a trigger, or if what you’re experiencing is an early symptom of a migraine attack.

Studies have found that sometimes what you may think is a trigger is actually to do with the ‘premonitory’ or ‘warning’ stage of a migraine attack. This is an early stage of the attack before the pain starts. During this stage, you may get symptoms such as changes in your mood or emotions, cravings for certain foods, and being more sensitive to light, sound or smells.

If the actual reliable triggers are known, it can be simple to avoid them. However, it may be harder to avoid attacks that are triggered by a combination of things. It is still best to strive for regularity in activities you can control such as sleep, meals, hydration, exercise and stress. Weather change, hormonal fluctuations, and certain stress levels can be harder to avoid. General improvements in your lifestyle can mean that you are more able to cope with migraine attacks, as you are healthier and fitter. You should aim to exercise regularly and eat a well-balanced diet.

Heat / cold packs – when attacks occur, some people find it helpful to apply cold or hot packs. These can be soothing and relieving

Exercise – frequent migraine attacks can increase neck and shoulder tightness which many people find uncomfortable, but can also make their migraines worse. It can be relieving to do regular gentle stretches to avoid a build up of neck and shoulder discomfort. These can be accessed, for example, from a physiotherapist who will advise on the exercises that are best for you, especially if there are other medical conditions to consider.

Supplements – many people with migraine try supplements to help their symptoms. There are many different supplements that claim to be helpful for migraine. However, there is limited evidence about how effective these are. Only a few have some evidence to show potential benefit including riboflavin (400mg), magnesium (600mg) and Co-enzyme Q10 (150mg). Specific doses for migraine are recommended and these are higher doses than those recommended for general dietary use.

As with medicines, they can take six to eight weeks to develop the full benefit. If you are going to start a supplement for migraine speak to your GP to make sure there are no reasons it may be unsafe for you (e.g. interacting with other medications).

Devices – non-invasive medical devices such as sTMS and Cefaly. These two medical devices can be helpful for migraine:

  • sTMS: The treatment involves placing the sTMS device against the back of your head for a second to deliver a very brief pre-set magnetic pulse. The device is called sTMS mini. It is portable, rechargeable and reusable. It is activated on a regular basis (usually every three months) with a prescription. Studies have shown that sTMS can reduce the severity and overall number of migraine attacks. It has been used to treat migraine attacks when they occur and also on a daily basis with a recommended number of pulses, to prevent attacks. NHS funding for sTMS can be considered by an Individual Funding Request (IFR) or special arrangements at some headache clinics. You should contact your local headache clinic directly to check if they can prescribe it.
  • Cefaly: On the basis that most headaches and migraine involve the trigeminal nerve. The trigeminal nerve is a nerve in the head, part of which runs around above your eye. This is the part of the trigeminal nerve that is targeted by the Cefaly device. An adhesive electrode is positioned on the forehead and Cefaly connects to this. Through the electrode, Cefaly generates precise micro-impulses in order to stimulate the nerve endings of the trigeminal nerve. Neurostimulation of the trigeminal nerve with Cefaly aims to produce a sedative or calming effect. Regular repetition of this effect is thought to reduce the number of attacks of migraine. It needs to be self-funded.

Acupuncture – for migraine, NICE stated that a course of up to 10 sessions of acupuncture over five to eight weeks can be considered if both migraine preventive treatments topiramate and propranolol are unsuitable or ineffective (these guidelines were published in 2015, before the availability of a range of newer migraine preventive treatments). It said that this would also depend on the patient’s choice of treatment, other conditions they may have, and risk of adverse effects to them from the treatment. Therefore, for some people, this can provide additional or temporary relief, as an alternative to medications. While acupuncture it not widely available across the NHS, almost all NHS pain clinics use it as a treatment and increasing numbers of GPs and physiotherapists are using it too.