Headache Treatment: Complementary and Alternative Options

Up to 82% of patients with headaches turn to complementary and alternative medicine (CAM) for relief, frequently without first consulting a physician.

Since CAM products are exempt from FDA review, information about their safety and efficacy is scarce and often conflicted.

After extracting recommendations from the American Academy of Neurology (AAN)/American Headache Society (AHS) 2012 guidelines, a review article published in the August 2015 issue of Continuum summarized available data for several CAM therapies.

Riboflavin, coenzyme Q10 (CoQ₁₀), magnesium, Petasites hybridus, feverfew, and melatonin are the most commonly used CAM products for headache.

Riboflavin (vitamin B₂) galvanizes mitochondrial energy production, which may be deficient in patients with migraine. Citing good evidence, the AAN claims that riboflavin is likely effective for migraines in adults. The product also boasts a favorable side effect profile, which consists of rarely occurring diarrhea and polyuria, as well as bright yellow urine. Riboflavin is not recommended for migraine prevention in children.

CoQ₁₀ is a component of the electron transport chain that maintains mitochondrial energy stores just like riboflavin. Unlike riboflavin, however, the AAN classifies CoQ₁₀ as only possibly effective. CoQ₁₀ is well tolerated, with anorexia, dyspepsia, nausea, and diarrhea occurring in less than 1% of subjects.

Sometimes, patients with headaches have low magnesium levels, which may potentiate migraine development by decreasing opposition to neuronal excitability. Limited evidence indicates that increased supplemental or dietary magnesium, an N-methyl-D-aspartate (NMDA) receptor inhibitor, may prevent migraine. Two studies even reported improved response rates in acute migraine after intravenous magnesium sulfate, particularly for migraine patients with aura.

Petasites hybridus, or butterbur shrub, possesses antihistamine, antileukotriene, and calcium channel-modulating effects. The AAN/AHS 2012 guidelines identify Petasites as effective for migraine prevention, but they advise caution because it can cause severe hepatotoxicity. Clinicians should monitor liver function regularly in migraine patients treated with Petasites.

Although feverfew’s mechanism of action in migraine prevention is unknown, the AAN/AHS 2012 Guidelines cite good evidence. It appears to be well tolerated. Long-term safety data are lacking.

Unlike the rest of the most commonly used CAM products for headache, melatonin is not recommended for migraine or cluster headache.