Prevalence, Pattern and Predictors of use of Complementary and Alternative Medicine (CAM) in Migraine Patients Attending a Headache Clinic in Italy

Migraine patients' experiences with and expectations from physiotherapy

BACKGROUND

Neck pain is prevalent in migraine and a common reason to receive physiotherapy. There is no information as to the type of modalities patients receive and whether these are perceived as effective and matching expectations.

METHODS

A survey was designed with closed and open-ended questions allowing for quantitative evaluation and qualitative insights into experiences and expectations. The survey was available online from June-November 2021 and was disseminated in the German migraine league (patient organization) and via social media. Open questions were summarized using qualitative content analysis. Differences between receiving and not receiving physiotherapy were analyzed through Chi2 or Fisher's Test. Categories within groups through Chi2-goodness-of-fit-test and multivariate logistic regression indicated perceived clinical improvement.

RESULTS

149 (123 received physiotherapy) patients completed the questionnaire. Patients receiving physiotherapy had higher pain intensity (p < 0.001) and migraine frequency (p = 0.017). Most participants received 6 sessions or less (38%) (past 12 months) of manual therapy (82%) and soft-tissue techniques (61%). 63% perceived benefits after manual therapy, and 50% after soft-tissue techniques. Logistic regression revealed that ictal and interictal neck pain (OR: 9.12 and 6.41, respectively) and receiving manual therapy (OR: 5.52) are associated with improvement. Mat exercises and higher migraine frequency increased the odds for no improvement or worsening (OR: 0.25 and 0.65, respectively). Expectations included individualized and targeted treatment from a specialized physiotherapist (39%), easier access, more and longer sessions (28%), manual therapy (78%), soft-tissue techniques (72%) and education (26%).

CONCLUSION

sThis first study on migraine patients' views on physiotherapy can serve as insight for researchers for future studies and clinicians to improve future care.

Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with migraine: a web-based survey study

Background

Since the declaration COVID-19 as a pandemic, healthcare systems around the world have faced a huge challenge in managing patients with chronic diseases. Patients with migraine were specifically vulnerable to inadequate medical care. We aimed to investigate the “real-world” impact of COVID-19 pandemic on migraine patients, and to identify risk factors for poor outcome.

Methods

We administered an online, self-reported survey that included demographic, migraine-related, COVID-19-specific and overall psychosocial variables between July 15 and July 30, 2020. We recruited a sample of patients with migraine from headache clinic registry and via social media to complete an anonymous survey. Outcomes included demographic variables, change in migraine frequency and severity during the lockdown period, communication with treating physician, compliance to migraine treatment, difficulty in getting medications, medication overuse, symptoms of anxiety and/or depression, sleep and eating habits disturbance, screen time exposure, work during pandemic, use of traditional medicine, effect of Botox injection cancellation, and overall worries and concerns during pandemic.

Results

A total of 1018 patients completed the survey. Of the respondents, 859 (84.3%) were females; 733 (71.9%) were aged 20 to 40 years, 630 (61.8%) were married, and 466 (45.7%) reported working during the pandemic.

In comparison to pre-pandemic period, 607 respondents (59.6%) reported increase in migraine frequency, 163 (16%) reported decrease in frequency, and 105 (10.3%) transformed to chronic migraine. Severity was reported to increase by 653 (64.1%) respondents. The majority of respondents; 626 (61.5%) did not communicate with their neurologists, 477 (46.9%) reported compliance to treatment, and 597 (58.7%) reported overuse of analgesics. Botox injections cancellation had a negative impact on 150 respondents (66.1%) from those receiving it. Forty-one respondents (4%) were infected with COVID-19; 26 (63.4%) reported worsening of their headaches amid infection period. Sleep disturbance was reported by 794 (78.1%) of respondents, and 809 (79.5%) reported having symptoms of anxiety and/or depression.

Conclusions and relevance

COVID-19 pandemic had an overall negative impact on patients with migraine. Several risk factors for poor outcome were identified. Long-term strategies should be validated and implemented to deliver quality care for patients with migraine, with emphasis on psychosocial well-being.

A ketogenic diet normalizes interictal cortical but not subcortical responsivity in migraineurs

Background

A short ketogenic diet (KD) treatment can prevent migraine attacks and correct excessive cortical response. Here, we aim to prove if the KD-related changes of cortical excitability are primarily due to cerebral cortex activity or are modulated by the brainstem.

Methods

Through the stimulation of the right supraorbital division of the trigeminal nerve, we concurrently interictally recorded the nociceptive blink reflex (nBR) and the pain-related evoked potentials (PREP) in 18 migraineurs patients without aura before and after 1-month on KD, while in metabolic ketosis. nBR and PREP reflect distinct brain structures activation: the brainstem and the cerebral cortex respectively. We estimated nBR R2 component area-under-the-curve as well as PREP amplitude habituation as the slope pof the linear regression between the 1st and the 2nd block of 5 averaged responses.

Results

Following 1-month on KD, the mean number of attacks and headache duration reduced significantly. Moreover, KD significantly normalized the interictal PREP habituation (pre: + 1.8, post: − 9.1, p = 0.012), while nBR deficit of habituation did not change.

Conclusions

The positive clinical effects we observed in a population of migraineurs by a 1-month KD treatment coexists with a normalization at the cortical level, not in the brainstem, of the typical interictal deficit of habituation. These findings suggest that the cerebral cortex may be the primary site of KD-related modulation.

Trial registration

ClinicalTrials.gov NCT03775252 (retrospectively registered, December 09, 2018).

Use of traditional medicine for primary headache disorders in Kuwait

BACKGROUND

Traditional Medicine (TM) is widely accepted to be used for the treatment headache disorders in Kuwait however, researches remain poorly documented. We aimed to study the frequency of TM use and its impact in the primary headache patients.

METHODS

This is a cross sectional self-reported efficacy study, which was conducted in Headache clinic in Kuwait throughout 6 months. Patients who were diagnosed with primary headache disorders of both genders aged from 18 to 65 years were included. Self-reported questionnaires were distributed to patients who used TM in the previous year. It included demographic, and characteristics of headache (headache frequency, duration, number of analgesic used in days per month and severity of headache). TM queried included blood cupping (Hijama), head banding, herbal medicine (sabkha), and diet modification. It assessed characters of headache before and 3 months after the final TM session. Independent sample t test, paired sample t test and Chi-square test were used to compare between different values. P < 0.05 is considered significant.

RESULTS

A total of 279 patients were included. The mean age is 40.32 ± 11.75 years; females represented 79.6% of the cohort. Most patients (n = 195; 69.9%) reported the use of TM before presentation to headache clinic, mainly Hijama (47.3%). Cultural / religious beliefs were the cause of seeking TM in 51.3% versus 10% used it due to ineffective medical treatment and 8.6% used it because of intolerance of medical treatment. Patients used TM were older at the onset of headache (24.24 ± 10.67 versus 20.38 ± 8.47; p < 0.003), and had longer headache disease duration (19.26 ± 13.13 versus 16.12 ± 11.39; p < 0.044). All patients with chronic headache (100%) and most of episodic migraine patients (90.4%) sought TM while only (31.5%) of Tension type headache sought TM; p < 0.047. Patients who sought TM had more frequent episodes of headache, longer duration of attacks and higher number of days of analgesic-usage respectively over last 3 months before presentation to our side (9.66 ± 7.39 versus 4.14 ± 2.72; p < 0.001), (41.23 ± 27.76 versus 32.19 ± 23.29; p <. 0009), (8.23 + 7.70 versus 3.18 ± 3.06; p < 0.001). At 3 months after the final TM session, there was no significant reduction of frequency of headache days per month (9.19 ± 7.33 versus 8.99 ± 7.59; p < 0.50), days of analgesic use per month (7.45 ± 7.43 versus 6.77 ± 6.93; p < 0.09) and duration of headache (41.23 ± 27.76 versus 41.59 ± 27.69; p < 0.78). However, there was a significant reduction of the severity of headache (p < 0.02). Few patients (17.9%) reported adverse events with TM. Most of TM cohorts were not satisfied after receiving this type of medicine.

CONCLUSION

TM was widely used in Kuwait for primary headache. Patients sought TM before seeking physician because they found them more congruent with their own cultural and religious beliefs. Health care professionals involved in the management of headache should be aware of this and monitor potential benefits or adverse events of TM. The usage of TM was not effective in reducing headache attacks and severity.

Efficacy of Nimodipine Plus Yufeng Ningxin Tablets for Patients with Frequent Migraine

BACKGROUND/AIMS

To test the effects of Nimodipine plus Yufeng Ningxin tablets on frequent migraine.

METHODS

Two hundred forty-two patients with frequent migraine were divided into the control group with those consuming Flunarizine (120 cases) and the treatment group with those consuming Nimodipine plus Yufeng Ningxin tablets (122 cases). The course of frequent migraine treatment lasted 7 weeks. The number of migraine days, visual analogue scale (VAS) score, and response rate were measured.

RESULTS

There was significant difference in the cure rate as the Nimodipine plus Yufeng Ningxin tablets group compared with the Flunarizine group (78.7 vs. 21.7%; p < 0.001). Fewer migraine days and VAS score were observed in the treatment group when compared with the control group (p < 0.05). Nimodipine plus Yufeng Ningxin tablets were superior to Flunarizine in terms of the response rate at week 7 (p < 0.05).

CONCLUSION

Due to its high cure rate, treatment with Nimodipine plus Yufeng Ningxin tablets is recommended to control frequent migraine, and this hypothesis needs to be confirmed through further studies conducted on a more extensive population.

Comparison of the Prophylactic Effect Between Acupuncture and Acupressure on Menstrual Migraine: Results of a Pilot Study

OBJECTIVES

To compare between acupuncture and acupressure for preventing menstrual migraine (MM).

METHODS

MM is one kind of migraine associated with menses in female. It is often associated with increased menstrual distress and disability, leading to decreased daily activity and quality of life. A randomized and controlled pilot study was conducted with three groups: verum acupuncture (VA) group, acupressure (AP) group, and control acupuncture (CA) group. The study lasted for 7 cycle-months, with a 1 cycle-month baseline observation (T1), a 3 cycle-month intervention (3 times per cycle-month) (T2-T4), and a 3 cycle-month follow-up (T5-T7). Outcome measures were number of migraine days, average and peak pain, total duration period of MM, and percentage of patients with ≥50% reduction in the number of MM days.

RESULTS

A total of 18 participants were included in the analysis (VA, n = 7; AP, n = 6; CA, n = 5). Both VA and AP were significantly more effective than CA for reducing MM days during the intervention period. Both VA and AP tended to be more effective than CA for reducing peak pain during the intervention period. No significant differences for the outcomes were observed among VA, AP, and CA during the follow-up period. No serious adverse events were reported.

DISCUSSION

Results of the pilot study suggest that both VA and AP could be considered as alternative and safe prophylactic interventions for MM. Register ClinicalTrials.gov Identifier: NCT02592681.

A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness

Background

Despite the expansion of conventional medical treatments for headache, many sufferers of common recurrent headache disorders seek help outside of medical settings. The aim of this paper is to evaluate research studies on the prevalence of patient use of manual therapies for the treatment of headache and the key factors associated with this patient population.

Methods

This critical review of the peer-reviewed literature identified 35 papers reporting findings from new empirical research regarding the prevalence, profiles, motivations, communication and self-reported effectiveness of manual therapy use amongst those with headache disorders.

Results

While available data was limited and studies had considerable methodological limitations, the use of manual therapy appears to be the most common non-medical treatment utilized for the management of common recurrent headaches. The most common reason for choosing this type of treatment was seeking pain relief. While a high percentage of these patients likely continue with concurrent medical care, around half may not be disclosing the use of this treatment to their medical doctor.

Conclusions

There is a need for more rigorous public health and health services research in order to assess the role, safety, utilization and financial costs associated with manual therapy treatment for headache. Primary healthcare providers should be mindful of the use of this highly popular approach to headache management in order to help facilitate safe, effective and coordinated care.

Effect of Prayer on Intensity of Migraine Headache: A Randomized Clinical Trial

BACKGROUND AND AIM

Migraine is a common form of headache that affects patients quality of life negatively. In addition to pharmacologic treatment, there are a variety of nonpharmacologic treatments for migraine headache. In present study, we examined the effect of prayer on intensity of migraine pain.

METHODS

In a prospective, randomized, controlled trial from October 2013 to June 2014, this study has been conducted in Kerman, Iran. We randomly assigned 92 patients in 2 groups to receive either 40 mg of propranolol twice a day for 2 month (group "A") or 40 mg of propranolol twice a day for 2 months with prayer (group "B"). At the beginning of study and 3 months after intervention, patients' pain was measured using the visual analogue scale.

RESULTS

At the beginning of study and before intervention, the mean score of pain in patients in groups A and B were 5.7 ± 1.6 and 6.5 ± 1.9, respectively. According to results of independent t test, mean score of pain intensity at the beginning of study were similar between patients in 2 groups (P > .05). Three month after intervention, mean score of pain intensity decreased in patients in both groups. At this time, the mean scores of pain intensity were 5.4 ± 1.1 and 4.2 ± 2.3 in patients in groups A and B, respectively. This difference between groups was statistically significant (P < .001).

CONCLUSIONS

The present study revealed that prayer can be used as a nonpharmacologic pain coping strategy in addition to pharmacologic intervention for this group of patients.

Electroacupuncture Pretreatment at GB20 Exerts Antinociceptive Effects via Peripheral and Central Serotonin Mechanism in Conscious Migraine Rats

Background. While electroacupuncture (EA) pretreatment in migraine has been found to attenuate pain and frequencies of attacks, the underlying mechanism of its antinociceptive effect remains poorly understood. Emerging evidence suggests that the serotonin system may be involved in migraine pathophysiology. Method. Forty male Sprague-Dawley rats were randomly assigned to Control, Model, EA, and sham acupuncture (SA) groups. HomeCageScan was used to measure the effects on spontaneous nociceptive behaviors. Radioimmunoassay and high-performance liquid chromatography were used to evaluate the expression of 5-hydroxytryptamine (HT) in the plasma and three-key structure of the descending pain modulatory system. Results. Our study showed that EA pretreatment could produce a significant reduction in resting, freezing, and grooming behavior and a significant increase in exploration behavior. Furthermore, we found that the level of 5-HT in plasma was significantly increased, and it was significantly decreased in the descending pain modulatory system in Model group. The aforementioned results were significantly reversed in EA group; that is, the level of 5-HT was increased in the rostroventromedial medulla (RVM) and trigeminal nucleus caudalis (TNC) region and decreased in the plasma. Conclusion. EA pretreatment exerts antinociceptive effects in a rat model of recurrent migraine, possibly via modulation of the serotonin system.

Diet and nutraceutical interventions for headache management: A review of the evidence

Background

The use of complementary and alternative medicines (CAM) is common among patients with primary headaches. In parallel, CAM research is growing. Diet interventions comprise another category of non-pharmacologic treatment for primary headache that is of increasing clinical and research interest.

Methods

A literature search was carried out to identify studies on the efficacy of diet and nutraceutical interviews for primary headache in the pediatric and adult populations. MEDLINE, Embase and EBM Reviews—Cochrane Central Register of Controlled Trials were searched to identify studies.

Results

There is a growing body of literature on the potential use of CAM and diet interventions for primary headache disorders. This review identified literature on the use of a variety of diet and nutraceutical interventions for headache. Most of the studies assessed the efficacy of these interventions for migraine, though some explored their role in tension-type headache and cluster headache. The quality of the evidence in this area is generally poor.

Conclusions

CAM is becoming more commonplace in the headache world. Several interventions show promise, but caution needs to be exercised in using these agents given limited safety and efficacy data. In addition, interest in exploring diet interventions in the treatment of primary headaches is emerging. Further research into the efficacy of nutraceutical and diet interventions is warranted.

Does complementary and alternative medicine (CAM) use reduce negative life impact of headaches for chronic migraineurs? A national survey

Background

Chronic migraine is a disabling condition that impacts multiple aspects of migraineurs’ lives. Although pharmacological treatments can help to treat the pain associated with migraine headache, chronic migraineurs often experience side-effects of pharmacological treatments. Those experiences may contribute to the observed growth in complementary and alternative medicine (CAM) use among migraineurs. Relatively little is known about the patterns of CAM treatment and the characteristics of chronic migraineurs. Therefore, the purpose of the present study is to investigate the characteristics of chronic migraineurs who use CAM treatment and the relationship among satisfaction with current CAM use, negative life impact, migraine outcomes, and psychiatric comorbidities among chronic migraineurs.

Methods

2907 participants were recruited from a well-known online migraine headache resource. All participants were US adults aged 18 years or older. Migraineurs are referred to this website through various routes (e.g., referral from healthcare providers, internet search, obtaining information from research papers, personal invitation from other users, and information shared on social media etc.). Participants completed a 30-min self-report-survey in the spring of 2014.

Results

Almost half of the participants reported that they are currently using more than three different CAM treatments even though the majority of the participants reported neutral or dissatisfied with their current CAM treatment. Chronic migraineurs who use CAM treatments were more likely to experience prolonged or frequent migraine headaches (p = .018, η² = .0021), and experience greater negative life impact from their headaches (p = .000, η² = .0172) compared to non-CAM users. CAM treatment satisfaction was inversely related to the number of psychiatric comorbidities, frequency of migraines, and number of migraine symptoms (p’s < .05). However, CAM treatment satisfaction was more strongly correlated with migraine outcomes than psychiatric comorbidities.

Conclusions

Chronic migraineurs often pursue multiple CAM treatments in spite of low levels of satisfaction with those treatments. Patients who experience relief from traditional treatments are less likely to seek the out additional CAM treatments. Thus it is often the sicker migraine patients who use CAM. More attention is needed to consider migraine treatment resistance, and psychological factors in planning the treatment of chronic migraineurs as those factors may play an important role in treatment choices by patients.

Cortical functional correlates of responsiveness to short-lasting preventive intervention with ketogenic diet in migraine: a multimodal evoked potentials study

BACKGROUND

Here, we aim to identify cortical electrofunctional correlates of responsiveness to short-lasting preventiveintervention with ketogenic diet (KD) in migraine.

METHODS

Eighteen interictal migraineurs underwent visual (VEPs) and median nerve somatosensory (SSEPs) evokedpotentials before and after 1 month of KD during ketogenesis. We measured VEPs N1-P1 and SSEPs N20-P25 amplitudes respectively in six and in two sequential blocks of 100 sweeps as well as habituation as theslope of the linear regression between block 1 to 6 for VEPs or between 1 to 2 for SSEPs.

RESULTS

After 1-month of KD, a significant reduction in the mean attack frequency and duration was observed (all P< 0.001). The KD did not change the 1st SSEP and VEP block of responses, but significantly inducednormalization of the interictally reduced VEPs and SSEPs (all p < 0.01) habituation during the subsequentblocks.

CONCLUSIONS

KD could restore normal EPs habituation curves during stimulus repetition without significantly changing theearly amplitude responses. Thus, we hypothesize that KD acts on habituation regulating the balancebetween excitation and inhibition at the cortical level.

Acupuncture for Frequent Migraine: A Randomized, Patient/Assessor Blinded, Controlled Trial with One-Year Follow-Up

Objectives. This study aimed to evaluate the efficacy and safety of manual acupuncture as a prophylaxis for frequent migraine. Methods. Fifty frequent migraineurs were randomly allocated to receive 16 sessions of either real acupuncture (RA = 26) or sham acupuncture (SA = 24) during 20 weeks. The primary outcomes were days with migraine over four weeks, duration, and intensity of migraine and the number of responders with more than 50% reduction of migraine days. The secondary outcomes were the relief medication, quality of migraine, quality of life, and pressure pain thresholds. Results. The two groups were comparable at baseline. At the end of the treatment, when compared with the SA group, the RA group reported significant less migraine days (RA: 5.2 ± 5.0; SA: 10.1 ± 7.1; P = 0.008), less severe migraine (RA: 2.18 ± 1.05; SA: 2.93 ± 0.61; P = 0.004), more responders (RA: 19 versus SA: 7), and increased pressure pain thresholds. No other group difference was found. Group differences were maintained at the end of the three-month follow-up, but not at the one-year follow-up. No severe adverse event was reported. Blinding was successful. Discussion. Manual acupuncture was an effective and safe treatment for short-term relief of frequent migraine in adults. Larger trials are warranted.

What attitudes and needs do citizens in Europe have in relation to complementary and alternative medicine?

BACKGROUND

Surveys from several European countries suggest a European-wide increase in the use of Complementary and Alternative Medicine (CAM). To safeguard citizens' rights concerning their healthcare, it is critical to gain an overview of citizens' attitudes and to understand their expectations and needs regarding CAM.

METHODS

A review of literature was undertaken, based on systematic searches of the following electronic databases: PubMed, Web of Science, CINHAL, AMED, PsycINFO and PsycArticles; 189 articles met inclusion criteria. Articles were analysed thematically and their reporting quality assessed.

RESULTS

Despite the limited availability of research-based knowledge about citizens' attitudes and needs concerning CAM in many European countries, some trends can be noted. Many citizens hold positive attitudes to CAM and wish for increasing access to CAM provision. Citizens call for impartial, reliable and trustworthy information to support informed decision-making, and some citizens wish for greater support and involvement of biomedical healthcare professionals in facilitating their healthcare choices. While citizens value distinct aspects of CAM practice, they are also critical consumers and support clear regulatory and educational frameworks to ensure the quality and safety of CAM provision and medicinal products.

CONCLUSION

To gain knowledge on citizens' needs and attitudes to CAM across Europe further research is required on 3 main issues: i) how citizens across Europe obtain information about CAM and the needs they may have for trustworthy information sources, ii) the local situations for accessing CAM and iii) citizens' perspectives on the quality of care and safety of CAM provision and products.

The traditional Chinese medicine prescription patterns for migraine patients in Taiwan: a population-based study

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional Chinese medicine (TCM), when given for symptom relief, has gained widespread popularity among migraine patients. The aim of this study is to analyze the utilization of TCM among migraine patients in Taiwan.

MATERIALS AND METHODS

The usage, frequency of service, and the Chinese herbal products prescribed for migraine were evaluated using a representative sample of one million subjects selected at random from the 22 million beneficiaries of the National Health Insurance scheme of Taiwan.

RESULTS

Overall, 89.3% (N=12,827) migraine patients utilized TCM and 24.2% of them sought TCM with the intention of treating their migraine-related symptoms. Migraine patients who are living in urban area and those with an episodic migraine pattern (<15 days/month) (aOR=3.18, 95% CI: 2.75-3.67) were more likely to be TCM users than those living in a rural area and those who suffered from chronic migraine (≥15 days/month) (aOR=1.00). Overall, 81.2% of TCM visits involved the prescription of a Chinese herbal remedy or remedies and Chuan-Xiong-Cha-Tiao-San, Jia-Wei-Xiao-Yao-San, Ge-Gen-Tang, Xue-Fu-Zhu-Yu-Tang, Ban-Xia-Bai-Zhu-Tian-Ma-Tang, Qing-Shang-Juan-Tong-Tang, Xiao-Chai-Hu-Tang, Tian-Ma-Gou-Teng-Yin, Bu-Zhong-Yi-Qi-Tang, and Tian-Wang-Bu-Xin-Dan were the ten most frequently prescribed formula for treating migraine based on syndrome differentiation.

CONCLUSIONS

Chuan-Xiong-Cha-Tiao-San, which contains sedative and anti-inflammatory agents, is the most commonly prescribed Chinese herbal formula for the treatment of migraine-related phenomena.

Latin American consensus on guidelines for chronic migraine treatment

Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.

Self-reported efficacy of complementary and alternative medicine: the Akershus study of chronic headache

Background

Chronic headache is associated with disability and high utilisation of health care including complementary and alternative medicine (CAM).

Findings

We investigated self-reported efficacy of CAM in people with chronic headache from the general population. Respondents with possible self-reported chronic headache were interviewed by physicians experienced in headache diagnostics. CAM queried included acupuncture, chiropractic, homeopathy, naprapathy, physiotherapy, psychological treatment, and psychomotor physiotherapy. Sixty-two % and 73% of those with primary and secondary chronic headache had used CAM.

Self-reported efficacy of CAM ranged from 0-43% without significant differences between gender, headache diagnoses, co-occurrence of migraine, medication use or physician contact.

Conclusion

CAM is widely used, despite self-reported efficacy of different CAM modalities is modest in the management of chronic headache.

Knowledge about and use of pharmacological and non-pharmacological headache therapies

OBJECTIVE

To analyse knowledge and use of pharmacological and non-pharmacological therapies in headache patients referred to a tertiary headache centre.

METHODS

We included 114 consecutive patients referred by a neurologist and asked them to fill out a comprehensive questionnaire immediately before their first appointment at our outpatient headache clinic. The questionnaire covered 23 compounds for acute treatment, 21 prophylactic drugs, and 30 complementary and alternative treatments.

RESULTS

The proportion of patients who knew at least one acute therapy stood at 92 %; 62 % knew at least one pharmaco-prophylaxis and 80 % knew at least one non-pharmacological treatment. Even though 87 % of the patients with migraine had ³ 4 disabling headache days per month, only 41 % had used triptans and not more than 19 % had taken drugs of first choice for migraine prophylaxis for at least 3 months. In contrast, 75 % had used complementary or alternative treatments. Univariate analyses showed several predictors for the use of pharmaco-prophylaxis and non-pharmacological treatment, of which only knowledge about pharmaco-prophylaxis predicted use of alternative treatments in multivariate analysis.

CONCLUSION

In Austria, a significant proportion of patients suffering from frequent recurrent headaches or migraines who are referred to a tertiary headache centre do not know and do not use triptans and pharmacological prophylaxis, while there is obviously broad acceptance and frequent use of mostly questionable alternative treatments. Improvement of primary and secondary care as well as patient education is desirable.

Complementary and alternative medicine use for headache and migraine: a critical review of the literature

CONTEXTS: An evidence base for complementary and alternative medicine (CAM) consumption within general populations is emerging. However, research data on CAM use for headache disorders remain poorly documented. This paper, constituting the first critical review of literature on this topic, provides a synopsis and evaluation of the research findings on CAM use among patients with headache and migraine.

METHODS

A comprehensive search of literature from 2000 to 2011 in CINAHL, MEDLINE, AMED, and Health Sources was conducted. The search was confined to peer-reviewed articles published in English reporting empirical research findings of CAM use among people with primary headache or migraine.

RESULTS

The review highlights a substantial level of CAM use among people with headache and migraine. There is also evidence of many headache and migraine sufferers using CAM concurrent to their conventional medicine use. Overall, the existing studies have been methodologically weak and there is a need for further rigorous research employing mixed method designs and utilizing large national samples.

DISCUSSION

The critical review highlights the substantial prevalence of CAM use among people with headache and migraine as a significant health care delivery issue, and health care professionals should be prepared to inquire and discuss possible CAM use with their patients during consultations. Health care providers should also pay attention to the possible adverse effects of CAM or interactions between CAM and conventional medical treatments among headache and migraine patients.

Management of primary chronic headache in the general population: the Akershus study of chronic headache

Primary chronic headaches cause more disability and necessitate high utilisation of health care. Our knowledge is based on selected populations, while information from the general population is largely lacking. An age and gender-stratified cross-sectional epidemiological survey included 30,000 persons aged 30–44 years. Respondents with self-reported chronic headache were interviewed by physicians. The International Classification of Headache Disorders was used. Of all primary chronic headache sufferers, 80% had consulted their general practitioner (GP), of these 19% had also consulted a neurologist and 4% had been hospitalised. Co-occurrence of migraine increased the probability of contact with a physician. A high Severity of Dependence Scale score increased the probability for contact with a physician. Complementary and alternative medicine (CAM) was used by 62%, most often physiotherapy, acupuncture and chiropractic. Contact with a physician increased the probability of use of CAM. Acute headache medications were taken by 87%, while only 3% used prophylactic medication. GPs manage the majority of those with primary chronic headache, 1/5 never consults a physician for their headache, while approximately 1/5 is referred to a neurologist or hospitalised. Acute headache medication was frequently overused, while prophylactic medication was rarely used. Thus, avoidance of acute headache medication overuse and increased use of prophylactic medication may improve the management of primary chronic headaches in the future.

Nutraceuticals and headache: the biological basis

Nutrition must affect the structure and functioning of the brain. Since the brain has very high metabolic activity, what we consume throughout the day is likely to dramatically influence both its structure and moment to moment function. It follows that nutritional approaches to all neurological disorders are being researched and entering medical practice, while nutraceutical use is a mainstay of public habits. This review discusses the biological basis for non-conventional or non-mainstream approaches to the treatment of migraine. This requires at least limited discussion of current migraine pathophysiologic theory. How nutrients and other chemicals and approaches are mechanistically involved within migraine pathways is the focus of this article. The nutraceuticals reviewed in detail are: magnesium, riboflavin, coenzyme Q10, petasites, and feverfew with additional comments on marijuana and oxygen/hyperbaric oxygen. This article reviews the science when known related to the potential genetic susceptibility and sensitivity to these treatments. As we know, the basic science in this field is very preliminary, so whether to combine approaches and presumably mechanisms or use them alone or with or without conventional therapies is far from clear. Nonetheless, as more patients and providers participate in patient-centered approaches to care, knowledge of the science underpinning nutritional, nutraceutical, and complementary approaches to treatment for migraine will certainly benefit this interaction.

Complementary and alternative medicine use among adults with migraines/severe headaches

OBJECTIVE

Our objective was to determine patterns, reasons for, and correlates of complementary and alternative medicine (CAM) use by US adults with migraines/severe headaches.

BACKGROUND

While many patients with chronic conditions use CAM, little is known about CAM use by adults with migraines/severe headaches.

METHODS

We compared CAM use between adults with and without self-reported migraines/severe headaches using the 2007 National Health Interview Survey (n=23,393), a national cross-sectional survey.

RESULTS

Adults with migraines/severe headaches used CAM more frequently than those without (49.5% vs 33.9%, P< .0001); differences persisted after adjustment (adjusted odds ratio=1.29, 95% confidence interval [1.15, 1.45]). Mind-body therapies (eg, deep breathing exercises, meditation, yoga) were used most commonly. More than 50% of adults with migraines/severe headaches reporting CAM use had not discussed it with their health care provider. Nonetheless, those with migraines/severe headaches used CAM more often than those without because of provider recommendation and because conventional treatments were perceived as ineffective or too costly. Correlates of CAM use among adults with migraines/severe headaches included anxiety, joint or low back pain, alcohol use, higher education, and living in the western USA. Only 4.5% of adults with migraines/severe headaches reported using CAM to specifically treat their migraines/severe headaches.

CONCLUSIONS

CAM is used more often among adults with migraines/severe headaches than those without. However, few report using CAM to specifically treat migraines/severe headaches. Mind-body therapies are used most frequently. Further research is needed to understand the effectiveness and mechanisms of CAM treatments in adults with migraines/severe headaches.

A comparative study of complementary and alternative medicine use among heterosexually and lesbian identified women: data from the ESTHER Project (Pittsburgh, PA, 2003-2006)

OBJECTIVES

The prevalence of complementary and alternative medicine (CAM) use among women in the United States is high. Little is known about how CAM use may differ based on sexual orientation. Study aims were to measure the prevalence of CAM use in a community sample of women, explore differences in CAM use patterns by sexual orientation, and identify correlates of CAM use.

DESIGN/SUBJECTS

Analyses were based on women (Total N = 879; n = 479 lesbians) enrolled in the Epidemiologic STudy of HEalth Risk in Women (ESTHER) Project, a cross-sectional heart-disease risk-factor study.

SETTINGS/LOCATION

Data were collected through convenience sampling of adult females in Pittsburgh, PA (2003-2006).

OUTCOME MEASURES

Main outcome measures included lifetime and past 12-month CAM use, and types of CAM modalities used in the past 12 months.

RESULTS

The prevalence of having ever used CAM was 49.8%, with 42% having reported CAM use within the past 12 months. Lesbians had greater odds of having ever used CAM (adjusted odds ratio [AOR] = 1.68 [95% confidence interval (CI): 1.23, 2.28]) and of having used CAM in the past 12 months (AOR = 1.44 [CI: 1.06, 1.97]) than heterosexuals. In multivariate analyses, correlates of lifetime and past 12-month CAM use included being lesbian, white, higher educated, and a large-city resident; experiencing perceived discrimination in a health care setting; and having a greater spirituality rating and a history of a diagnosed mental health disorder. Past 12-month CAM use was also associated with having a provider of usual health care. Among women who used CAM within the past 12 months, heterosexuals had significantly higher yoga participation rates than lesbians.

CONCLUSIONS

Sexual orientation is important in understanding lifetime and past 12-month CAM use. Because of the high prevalence of CAM use found in this study, medical practitioners should inquire about the CAM practices of female patients, particularly lesbians.

Anthroposophic therapy for migraine: a two-year prospective cohort study in routine outpatient settings

Background and Methods:

Anthroposophic treatment for migraine is provided by physicians and includes special artistic and physical therapies and special medications. We conducted a prospective cohort study of 45 consecutive adult outpatients (89% women) starting anthroposophic treatment for migraine under routine conditions. Main outcomes were Average Migraine Severity (physician and patient ratings 0-10, primary outcome), Symptom Score (patient rating, 0-10), and quality of life (SF-36); main follow-up time point was after six months.

Results:

The anthroposophic treatment modalities used were medications (67% of patients), eurythmy therapy (38%), art therapy (18%), and rhythmical massage therapy (13%). Median therapy duration was 105 days. In months 0-6, conventional prophylactic antimigraine medications were used by 14% (n=5/36) of evaluable patients.

From baseline to six-month follow-up, physician-rated Average Migraine Severity improved by 3.14 points (95% confidence interval 2.40-3.87, p<0.001); patient-rated Average Migraine Severity improved by 2.82 points (2.05-3.64, p<0.001); and Symptom Score improved by 2.32 points (1.68-2.95, p<0.001). In addition, three SF-36 scales (Social Functioning, Bodily Pain, Vitality), the SF-36 Physical Component summary measure, and the SF-36 Health Change item improved significantly. All improvements were maintained at last follow-up after 24 months. Patients not using conventional prophylactic antimigraine medications had improvements similar to the whole cohort.

Conclusions:

Patients with migraine under anthroposophic treatment had long-term improvement of symptoms and quality of life. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that anthroposophic therapies may be useful in the long-term care of patients with migraine.

The use of complementary and alternative medicine by patients attending a UK headache clinic

OBJECTIVES

This study was undertaken in order to determine the extent of the use of CAM in a UK headache clinic.

DESIGN

Ninety-two patients attending a headache clinic were given a questionnaire containing questions regarding their headaches and their use of CAM for headaches.

SETTING

Outpatient headache clinic, Birmingham, UK. Main outcome measures. The use of complementary and alternative therapies and predictive factors.

RESULTS

32% of respondents had used a median of 3 different CAM therapies for their headache. The commonest source of recommendation of CAM use was a friend or relative (72%) and the commonest reason given for using CAM was as a last resort after trying all conventional therapies offered (48%). CAM therapies were perceived as beneficial by 60% of CAM users and no users perceived the CAM therapy to worsen their headache. 42% of CAM users had not disclosed it to their doctor or nurse, 80% of these giving the reason that the doctor or nurse never asked, rather than fear of discouragement or lack of understanding. Individuals who were in employment were more likely to have used CAM than those who were not. Binary logistic regression revealed Headache Impact Test (HIT-6) score to be a significant predictor of CAM use (Odds Ratio=1.38 [95% CI 1.05-1.81]).

CONCLUSIONS

As a matter of desperation, headache clinic patients try CAM therapies. Health care professionals involved in the management of headache should be aware of this. There is a need for evaluation of the benefits and safety of CAM therapies for headache.

Response to Ayurvedic therapy in the treatment of migraine without aura

Migraine patients who do not respond to conventional therapy, develop unacceptable side-effects, or are reluctant to take medicines resort to complementary and alternative medicines (CAM). Globally, patients have been seeking various non-conventional modes of therapy for the management of their headaches. An Ayurvedic Treatment Protocol (AyTP) comprising five Ayurvedic medicines, namely Narikel Lavan, Sootshekhar Rasa, Sitopaladi Churna, Rason Vati and Godanti Mishran along with regulated diet and lifestyle modifications such as minimum 8 h sleep, 30-60 min morning or evening walk and abstention from smoking/drinking, was tried for migraine treatment. The duration of the therapy was 90 days. Out of 406 migraine patients who were offered this AyTP, 204 patients completed 90 days of treatment. Complete disappearance of headache and associated symptoms at completion of AyTP was observed in 72 (35.2%); mild episode of headache without need of any conventional medicines in 72 (35.2%); low intensity of pain along with conventional medicines in 50 (24.5%); no improvement in seven (3.4%) and worst pain was noted in three (1.4%) patients, respectively. In 144 (70.5%) of patients marked reduction of migraine frequency and pain intensity observed may be because of the AyTP. Though the uncontrolled open-label design of this study does not allow us to draw a definite conclusion, from this observational study we can make a preliminary assessment regarding the effectiveness of this ayurvedic treatment protocol.

Treatment of migraine and tension-type headache in Croatia

The aim of this study was to assess the treatment patterns of migraine and tension-type headache in the Croatian population. Analysis included the proportion of patients who were taking specific antimigraine therapy and the number of tablets per attack per month, the proportion of patients who were taking prophylactic therapy or using alternative treatment methods and their satisfaction with the treatment. The design of the study was a cross-sectional survey. Self-completed questionnaires were randomly distributed to adults >18 years of age in the Croatian population. A total of 616 questionnaires were analyzed: 115 patients with migraine (M), 327 patients with tension-type headache (TTH), and 174 patients with probable migraine (PM) and TTH. Specific antimigraine therapy was taken by half of patients with migraine: 35.7% of patients used triptans and 21.7% ergotamines. Prophylactic treatment had been used by 13.9% of M, 1.2% of TTH, and 6.9% of PM patients. Alternative methods of treatment were tried by 27% of M and TTH patients. Only 16.8% of patients with M pay regular visits to physicians, while 36.3% never visited a physician. More than half of TTH patients have never visited a physician. The majority of patients are only partially satisfied with their current treatment, and almost one-third are not satisfied. Results of this study indicate that the treatment of primary headaches in Croatia should be improved.

Use of complementary and alternative medicine in patients suffering from primary headache disorders

Complementary and alternative medicine (CAM) is increasingly common in the treatment of primary headache disorders despite lack of evidence for efficacy in most modalities. A systematic questionnaire-based survey of CAM therapy was conducted in 432 patients who attended seven tertiary headache out-patient clinics in Germany and Austria. Use of CAM was reported by the majority (81.7%) of patients. Most frequently used CAM treatments were acupuncture (58.3%), massage (46.1%) and relaxation techniques (42.4%). Use was motivated by 'to leave nothing undone' (63.7%) and 'to be active against the disease' (55.6%). Compared with non-users, CAM users were of higher age, showed a longer duration of disease, a higher percentage of chronification, less intensity of headache, were more satisfied with conventional prophylaxis and showed greater willingness to gather information about headaches. There were no differences with respect to gender, headache diagnoses, headache-specific disability, education, income, religious attitudes or satisfaction with conventional attack therapy. A higher number of headache days, longer duration of headache treatment, higher personal costs, and use of CAM for other diseases predicted a higher number of used CAM treatments. This study confirms that CAM is widely used among primary headache patients, mostly in combination with standard care.

Uninformed Complementary and Alternative Supplement Use: A Risky Behavior for Cardiovascular Patients

Growing use of complementary and alternative supplements (CAS) is of concern because of the potential for herb—drug interaction among cardiovascular patients. Literary searches were conducted on PubMed to identify reports of extent and purpose of CAS use, disclosure of use by patients, physician knowledge, and possible drug—CAS interactions for cardiovascular patients. Additional published studies were located through the Web sites of various organizations. Further searches of case reports, case series, controlled trials, and laboratory evidence were performed for each of the top 10 CAS and their possible cardiovascular drug interactions. More research is needed to understand supplement—drug interactions, particularly in terms of how this potentially affects patients taking cardiovascular drugs. With this lack of research and clarity on supplement—dug interactions and the underreporting of CAS use by many patients, physician education is also in need of improvement.

Factors and common conditions associated with adolescent dietary supplement use: an analysis of the National Health and Nutrition Examination Survey (NHANES)

Background

Little is known about the prevalence of dietary supplement (DS) use in American adolescents. We conducted this study to analyze the prevalence of DS use and factors associated with this use in a national population-based sample.

Methods

We used data from the 1999 – 2002 National Health and Nutrition Examination Surveys (NHANES) for adolescents age 11 to 19. Using weighted logistic regression, we identified demographic and clinical factors associated with the use of any DS, vitamins or minerals, herbs and other DS.

Results

Among the 5,306 responses representing approximately 36 million Americans 11–19 years old, 27% reported use of one or more DS in the prior month. The most commonly used DS were: multivitamins (16%) and vitamin C (6%). In the multivariable analysis, African American [adjusted odds ratio 0.40 (0.31–0.50) 95% CI] and Mexican American [0.55 (0.44–0.69)] adolescents were less likely to use DS compared with non-Hispanic whites. DS use was more common in those who used prescription medications [1.37 (1.10–1.72)] and among those who had a diagnosis of chronic headaches [1.25 (1.04–1.50)]. DS use was less common among those reporting fair or poor health status [0.59 (0.40–0.88)].

Conclusion

Twenty seven percent of American adolescents use DS. DS use is higher among teens that use prescription medications; physicians and pharmacists should be aware of this, ask patients, and check for potential interactions.

Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial

BACKGROUND

Numerous studies have explored the effectiveness of complementary and alternative medicine in the treatment of migraine but there is no documented investigation of the effectiveness of yoga therapy for migraine management.

OBJECTIVES

To investigate the effectiveness of holistic approach of yoga therapy for migraine treatment compared to self-care.

DESIGN

A randomized controlled trial.

METHODS

Seventy-two patients with migraine without aura were randomly assigned to yoga therapy or self-care group for 3 months. Primary outcomes were headache frequency (headache diary), severity of migraine (0-10 numerical scale) and pain component (McGill pain questionnaire). Secondary outcomes were anxiety and depression (Hospital anxiety depression scale), medication score.

RESULTS

After adjustment for baseline values, the subjects' complaints related to headache intensity (P < .001), frequency (P < .001), pain rating index (P < .001), affective pain rating index (P < .001), total pain rating index (P < .001), anxiety and depression scores (P < .001), symptomatic medication use (P < .001) were significantly lower in the yoga group compared to the self-care group.

CONCLUSION

The study demonstrated a significant reduction in migraine headache frequency and associated clinical features, in patients treated with yoga over a period of 3 months. Further study of this therapeutic intervention appears to be warranted.

Use of complementary and alternative medicine by patients with cluster headache: results of a multi-centre headache clinic survey

OBJECTIVES

To evaluate the rates, pattern, satisfaction with, and presence of predictors of complementary and alternative medicine (CAM) use in a clinical population of patients with cluster headache (CH).

DESIGN AND SETTING

One hundred CH patients attending one of three headache clinics were asked to undergo a physician-administered structured interview designed to gather information on CAM use.

RESULTS

Past use of CAM therapies was reported by 29% of the patients surveyed, with 10% having used CAM in the previous year. Only 8% of the therapies used were perceived as effective, while a partial effectiveness was reported in 28% of CAM treatments. The most common source of recommendation of CAM was a friend or relative (54%). Approximately 62% of CAM users had not informed their medical doctors of their CAM use. The most common reason for deciding to try a CAM therapy was that it offered a "potential improvement of headache" (44.8%). Univariate analysis showed that CAM users had a higher income, had a higher lifetime number of conventional medical doctor visits, had consulted more headache specialists, had a higher number of CH attacks per year, and had a significantly higher proportion of chronic CH versus episodic CH. A binary logistic regression analysis was performed and two variables remained as significant predictors of CAM use: income level (OR=5.7, CI=1.6-9.1, p=0.01), and number of attacks per year (OR=3.08, CI=1.64-6.7, p<0.0001).

CONCLUSION

Our findings suggest that CH patients, in their need of and quest for care, seek and explore both conventional and CAM approaches, even though only a very small minority finds them very satisfactory.

Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review

The objective of this review was to evaluate the strength of evidence of effectiveness for Petasites hybridus in the prophylaxis of migraine. Several databases and other sources were searched to identify randomised-controlled trials investigating P. hybridus preparations. Two trials totalling 293 patients (60 and 233 patients) were included in this review. Both trials investigated the proprietary Petasites root extract Petadolex. The trials were described in narrative way, taking into consideration methodological quality scores. Pooling of data was not carried out due to the heterogeneity of the results. The extract at higher dose (150 mg) showed a greater decreased frequency of migraine attacks and a greater number of responders (improvement>50%) after treatment over 3-4 months than the extract at lower dose (100 mg) and placebo. Moderate evidence of effectiveness is, thus, available for a higher than the recommended dose of the proprietary Petasites root extract Petadolex in the prophylaxis of migraine. Further rigorous studies are required to confirm effectiveness and safety in long-term use before treatment with Petasites root extract can be recommended as an alternative option in the treatment schedule for the prophylaxis of migraine.

Use of Complementary and Alternative Medicine by Patients With Chronic Tension-Type Headache: Results of a Headache Clinic Survey

OBJECTIVES

This study was undertaken to evaluate the rates, pattern, and presence of predictors of complementary and alternative medicine use in a clinical population of patients with chronic tension-type headache.

BACKGROUND

The use of complementary and alternative medicine in the treatment of headaches is a growing phenomenon about which little is known.

METHODS

A total of 110 chronic tension-type headache patients attending a headache clinic participated in a physician-administered structured interview designed to gather information on complementary and alternative medicine use.

RESULTS

Past use of complementary and alternative therapies was reported by 40% of the patients surveyed (22.7% in the previous year). Chronic tension-type headache patients prefer complementary and alternative practitioner-administered physical treatments to self-treatments, the most frequently used being chiropractic (21.9%), acupuncture (17.8%), and massage (17.8%). Only 41.1% of the patients perceived complementary and alternative therapies to be beneficial. The most common source of recommendation of complementary and alternative medicine was a friend or relative (41.1%). Most of the chronic tension-type headache patients used complementary and alternative treatment as a specific intervention for their headache (77.3%). Almost 60% of complementary and alternative medicine users had not informed their medical doctors of their use of complementary and alternative medicine. The most common reasons given for choosing to use a complementary or alternative therapy was the "potential improvement of headache" it offered (45.4%). The patients who had used more complementary and alternative treatments were found to be those recording a higher lifetime number of visits to conventional medical doctors, those with a comorbid psychiatric disorder, those enjoying a higher (household) income, and those who had never tried a preventive pharmacological treatment.

CONCLUSIONS

Our findings suggest that headache-clinic chronic tension-type headache patients, in their need of and quest for care, seek and explore both conventional and complementary and alternative therapies, even if only 41.1% of them perceived complementary treatments as effective. Physicians should be made aware of this patient-driven change in the medical climate in order to prevent misuse of health care resources and to be better equipped to meet patients' care requirements.