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Nonpharmacologic Treatments for Migraine and Tension-Type Headache: How to Choose and When to Use

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Opinion statement

There are a variety of nonpharmacologic treatments for headache. Educating patients about headache and its management, identifying and managing triggers (via diaries), modifying lifestyles, and understanding the importance of adopting and adhering to interventions (either pharmacologic or nonpharmacologic) are relevant to all persons with headache. In addition, specific nonpharmacologic treatments can be used either alone or in conjunction with ongoing pharmacologic intervention. Strong candidates for nonpharmacologic treatment include individuals with significant headache-related disability, comorbid mood or anxiety disorders, difficulty managing stress or other triggers, medication overuse, and patients who prefer a specific treatment. Behavioral treatments (relaxation, biofeedback, and cognitive-behavioral therapy) possess the most evidence for successful headache management. They have a long history of randomized trials showing efficacy and are considered first-line preventive options. Among complementary and alternative treatments, recent positive findings from randomized trials using acupuncture provide evidence of its potential as a first-line intervention. Other complementary and alternative techniques do not have a consistent base of research to recommend them for headache prevention, but they may be used if the patient prefers this approach or when other first-line interventions (nonpharmacologic or pharmacologic) have not provided adequate results. Among “natural” treatments, both butterbur extract and vitamin B2 have shown efficacy in more than one randomized trial and are thus potentially useful first-line preventive interventions.

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Disclosure

Conflicts of interest: R. Nicholson: Member of advisory board for Merck, grant from Merck, payment for consultative services with Mercy Health Research; D. Buse: none; F. Andrasik: none; R. Lipton: Member of Advisory Board of Allergan and Merck; payment from Allergan for educational presentations or speaking; grants from GlaxoSmithKline, Allergan, Merck, and Bristol Myers Squibb.

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Authors and Affiliations

  1. Department of Neurology & Psychiatry, Saint Louis University School of Medicine, 1402 S. Grand Blvd. Monteleone Hall, St. Louis, MO, 63104, USA

    Robert A. Nicholson PhD

  2. Department of Neurology, Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY, USA

    Dawn C. Buse PhD & Richard B. Lipton MD

  3. Department of Psychology, University of Memphis, Memphis, TN, USA

    Frank Andrasik PhD

  4. Ryan Headache Center, Mercy Health Research, St. Louis, USA

    Robert A. Nicholson PhD

Authors
  1. Robert A. Nicholson PhD
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  2. Dawn C. Buse PhD
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  3. Frank Andrasik PhD
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  4. Richard B. Lipton MD
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Correspondence to Robert A. Nicholson PhD.

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Nicholson, R.A., Buse, D.C., Andrasik, F. et al. Nonpharmacologic Treatments for Migraine and Tension-Type Headache: How to Choose and When to Use. Curr Treat Options Neurol 13, 28–40 (2011). https://doi.org/10.1007/s11940-010-0102-9

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