Migraine Resource Center

Migraine Resource Center

Perspective from Kathryn A. Boling, MD
Perspective from Stephen Silberstein, MD
Disclosures: The authors report no relevant financial disclosures.
February 24, 2021
5 min read
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Many patients with migraine do not ask providers about complementary, integrative medicine

Perspective from Kathryn A. Boling, MD
Perspective from Stephen Silberstein, MD
Disclosures: The authors report no relevant financial disclosures.
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In a recent social media survey, 90% of patients with migraine said they use complementary and integrative medicines like meditation, yoga and vitamins, but only about 20% discuss these treatment strategies with a health care provider.

“It is important for providers to be conversant with complementary and integrative medicine (CIM) treatments and the available evidence-based data,” Deena E. Kuruvilla, MD, a neurologist at Yale New Haven Health, and colleagues wrote in BMC Complementary Medicine and Therapies.

Among 335 patients with migraine who used CIM: 5.9% said it was “very effective;” 22.6% said it was “moderately effective;” 34.1% said it was “slightly effective;" 18.6% said it was “not effective at all;” and 18.6% did not answer.
Reference: Kuruvilla DE, et al. BMC Complement Med Ther. 2021;doi:10.1186/s12906-021-03226-0.

The researchers developed a confidential cross-sectional survey to identify common CIMs that patients with migraine use and ascertain which CIMs patients consider to be “most effective.” The survey was posted on Move Against Migraine’s Facebook page. It was completed by 372 individuals who were clinically diagnosed with migraine.

Overall, 90% of survey responders said they use CIM. Among them, 86.6% said they use CIM in combination with mainstream migraine treatments. Most survey responders who reported using CIM were women (94.3%), white (88.4%) and aged 35 to 44 years (24%), 45 to 54 years (23.3%) or 55 to 64 years (24.5%).

The researchers wrote that among all the survey respondents who reported using CIM, 56.4% used two or more. The most common CIMs were vitamins (18.8%), followed by meditation, relaxation, breathing exercises and/or guided imagery (5.6%), yoga (2.6%), cognitive behavioral therapy (2.6%), mindfulness training (1.19%), craniosacral therapy (0.59%) and biofeedback (0.59%). Another 13.4% respondents selected “other.”

In addition, among the entire cohort using CIM:

  • 5.9% reported it was “very effective” (led to a 50% to 100% reduction in headache days);
  • 22.6% said it was “moderately effective” (resulted in a 10% to 50% reduction in headache days);
  • 34.1% said it was “slightly effective” (led to a 1% to 10% reduction in headache days);
  • 18.6% said it was “not effective at all” (no change in the number of headache days); and
  • 18.6% did not answer.

About half of the survey respondents also reported using CBD oil or “other cannabis derivative” to prevent migraine. Among this subgroup:

  • 2.4% said it was “extremely effective;”
  • 8.5% said it was “very effective” (resulted in a 50% to 100% reduction in headache days);
  • 21.9% said it was “moderately effective” (led to a 10% to 50% reduction in headache days);
  • 26.2% said it was “slightly effective” (resulted in a 1% to 10% reduction in headache days); and
  • 39% said it was “not effective at all” (no change in the number of reduction days).

The researchers reported that 20.2% of survey participants sought guidance from a health care provider (MD, DO, NP or PA) regarding CIM, while 7.1% relied exclusively on the internet for CIM information, 3.5% sought guidance from another patient with migraine, 1.1% sought guidance from a naturopathic provider and 57.6% used two or more of these sources.

Kuruvilla and colleagues said the CARE mnemonic can be used to discuss CIM treatments with patients.

“It can be helpful to ask about their history with conventional treatments while also avoiding judgement,” they wrote. “When reviewing integrative treatment options, it is imperative to counsel patients on their limitations so that they have appropriate expectations. Finally, in order to adequately educate patients on CIM, it is helpful to explore where the patient’s interest in CIM stems from.”