Up to 40 million Americans, 75 percent of them women, suffer from migraine headaches. Symptoms can include throbbing head pain, nausea, vomiting, sensitivity to light and sound, fatigue, and dizziness. According to the World Health Organization, migraine is the second-leading cause of disability, with only back pain causing more downtime.
To prevent or relieve migraines, which can strike as often as every couple of days, doctors prescribe two types of drugs: preventive, to stop attacks before they start, and abortive, to stop attacks once they’ve started. But preventive drugs also can deliver debilitating side effects—memory loss, hair loss, bone loss, and much more. Because of the drugs’ downsides, only 20 percent of people with migraines (migraineurs) stick with these drugs long-term. In contrast, abortive drugs are mostly safe and reasonably effective: 30 percent of migraineurs who try them get good results, with few side effects. But if drugs don’t work, or if they cause troublesome side effects, there’s another option for migraine sufferers: non-drug treatments. Non-drug treatments are safe and inexpensive. And the best of them have scientific evidence to support their effectiveness.
Based on scientific research and decades of clinical experience, here are what I consider to be the eight best non-drug therapies to prevent and treat migraine:
- Aerobic exercise. Strong scientific evidence shows that aerobic exercise can improve migraines. A Swedish study of 91 migraineurs found that exercising for 40 minutes, three times a week, was as effective as topiramate (Topamax), a preventive migraine drug—with topiramate causing significant side effects in the study. And in a study by Swiss researchers, both high-intensity interval training and moderate-intensity exercise decreased the number of migraine headache days per month. This is the best non-drug way to prevent migraines, so try to follow the government’s official recommendation for regular exercise: a minimum of 30 minutes of moderate-intensity exercise (like brisk walking), at least five days a week.
- Meditation. Researchers from Wake Forest School of Medicine in Winston Salem, North Carolina, conducted a study on meditation with 19 migraineurs: 10 learned mindfulness-based stress reduction (MBSR) and nine received standard migraine care. Those practicing MBSR—meditating, on average, 20 minutes a day—had 1.4 fewer migraines per month, and the migraines were generally less severe and shorter.
There are several ways to learn meditation. You can listen to free podcasts by a wonderful meditation expert and psychologist, Tara Brach, PhD. An excellent book to learn meditation is Mindfulness in Plain English, by Bhanta Gunaratana. There are also apps for meditation, like headspace.com and calm.com. You can also find local meditation courses offered by churches, community centers, and gyms.
- Magnesium. Up to one-half of migraine sufferers are deficient in the mineral magnesium. I have conducted and published research on the positive role of magnesium in migraines—including a review paper in the Expert Review of Neurotherapeutics—and have seen dramatic improvement from magnesium in many of my patients. Ideally, you should obtain the mineral from magnesium-rich foods, such as whole grains, dark leafy vegetables, avocados, and legumes. But making sure you eat these foods on a regularly basis is not easy, and sometimes it’s not sufficient to raise magnesium levels. I strongly feel that every person with migraine headaches should try taking 400 milligrams (mg) of magnesium glycinate daily. For maximum absorption, take magnesium with a meal.
- Coenzyme Q10 (COQ10). After magnesium, a deficiency of coenzyme Q10—a necessary ingredient for the production of energy in every cell in the body—is the most common nutritional deficiency in migraineurs. In one study published in the journal Neurology, 48 percent of patients who were taking CoQ10 had a 50 percent decrease in migraines, compared with 14 percent who took a placebo. The study dose was 100 mg three times daily.
- Cognitive-behavioral therapy (CBT). This psychological therapy focuses on changing unhelpful ways of thinking and feeling and changing learned patterns of unhelpful behavior. For migraineurs, the main focus is on coping with and reducing the pain of headaches—such as learning how not to panic and become emotionally paralyzed by migraine headaches—and learning how to inform and interact with family, friends, and employers, who can be understanding and perhaps even helpful.
Therapy usually involves eight to 12 structured sessions. They may include an introduction to the CBT model involving thoughts, feelings, and behaviors; pain monitoring; relaxation training; avoiding migraine triggers; and how to pace daily activity. CBT is usually conducted by a social worker or psychologist. Group sessions are also effective. Online, web-based CBT is another good alternative. Two excellent sites that offer free CBT are www.thiswayup.org.au, and www.moodgym.anu.edu.au.
- Acupuncture. This modality from traditional Chinese medicine uses tiny needles to stimulate specific acupuncture points, balancing the flow of energy (qi, pronounced “chee”) within the body. There is a large body of scientific literature on the use of acupuncture for migraine, including studies that show acupuncture is more effective than standard pharmacological treatments. In an editorial published in Cephalagia, the journal of the International Headache Society, the author wrote, “…acupuncture should be offered to patients who do not respond to prophylactic [preventive] treatment with drugs, terminate drug treatment because of adverse events, or have contraindications to drug treatment.”
Acupuncture does have drawbacks, however. It is time-consuming, relatively expensive when compared with generic prescription drugs, and temporary. You need to continue having it done every week or two.
To locate a licensed acupuncturist in your area, consult the practitioner directory of the National Certification Commission for Acupuncture & Oriental Medicine (NCCAOM). https://www.nccaom.org/find-a-practitioner-directory.
- Transcutaneous nerve stimulation (TENS). In this migraine therapy, you attach electrodes to the skin. The electrodes are connected to a small, battery-operated device that delivers alternating current. Two types of TENS devices are particularly effective for migraine:
- Cefaly is a TENS device that is applied to the forehead. It’s approved by the FDA for the acute and preventive treatment of migraines. Some of my patients find it particularly effective for the acute treatment of migraine attacks. The cost of a unit is approximately $400. (A basic TENS unit costs as little as $50, but is awkward to apply to the forehead.)
- Nerivio is another device approved by the FDA for the acute treatment of migraine attacks. Unlike other TENS units, it involves stimulation of a remote site—the upper arm—to produce effects in the brain. The frequency of stimulation fluctuates through the session. Nervio is controlled by a smartphone app. In a study published in the journal Headache, participants used it for 45 minutes at the beginning of an attack. Over two hours, it was more effective than non-stimulation for pain relief. Users achieved a pain-free state and relief of bothersome symptoms like nausea and sensitivity to light and noise. Insurance may cover the device. Without it, prescription-only Nerivio costs $599 for 12 treatments.
8. Riboflavin (vitamin B2). This nutrient stimulates the production of energy in cells. In a three-month study published in the journal Neurology, 55 migraine patients received either a daily dose of 400 mg of riboflavin or a placebo. Fifty-nine percent of those taking the riboflavin improved by at least 50 percent, compared with 15 percent of those taking the placebo. However, the improvement occurred only in the third month, which means you need to give riboflavin plenty of time to work. Riboflavin has a fluorescent, yellow hue, and your urine may become bright yellow when you take the vitamin, but this is harmless. There are no serious side effects from taking 400 mg daily. (Despite its apparent safety, pregnant women should not take a 400 mg dose.)