Supported by multiple clinical trials and systematic reviews
Migraine
Migraine is a common, often disabling primary headache disorder characterized by recurrent attacks of moderate to severe head pain with sensory hypersensitivity (photophobia, phonophobia), nausea, and in some cases transient neurologic symptoms (aura). Diagnosis is clinical using ICHD-3 criteria, distinguishing episodic from chronic migraine (≥15 headache days/month for >3 months, with ≥8 days meeting migraine criteria). Western medicine emphasizes stratified acute therapy to rapidly abort attacks, preventive therapies to reduce monthly migraine days and severity, and identification of comorbidities and triggers (sleep disturbance, stress, hormonal shifts). Neurobiologically, migraine involves altered brainstem/trigeminovascular processing and neuropeptides (notably calcitonin gene-related peptide, CGRP). Over the last decade, migraine care has been transformed by targeted CGRP therapies and noninvasive neuromodulation devices alongside time-tested approaches (triptans, beta-blockers, topiramate, amitriptyline) and behavioral therapies. Eastern and traditional systems conceptualize migraine through different frameworks. Traditional Chinese Medicine (TCM) uses pattern differentiation (e.g., liver yang rising, blood stasis, phlegm-dampness) and treats with acupuncture, herbal formulas, and lifestyle harmonization. Acupuncture for migraine prevention has among the strongest evidence bases of any complementary therapy, with reductions in attack frequency comparable to standard preventives and fewer adverse effects. Ayurveda frames migraine (Ardhavabhedaka/Sooryavarta) within doshic imbalance and employs cleansing and local therapies (nasya, shirolepa) along with diet and daily routines. Mind–body modalities such as biofeedback, progressive muscle relaxation (PMR), and yoga address stress reactivity and autonomic balance with randomized data supporting reduced frequency and disability. Nutraceuticals like magnesium and riboflavin bridge paradigms and have guideline-end0
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.
Western Medicine
Diagnosis
ICHD-3: At least 5 attacks lasting 4–72 hours with ≥2 of the following (unilateral location, pulsating quality, moderate/severe intensity, aggravation by routine activity) and during headache ≥1 of nausea/vomiting or photophobia/phonophobia; not better accounted for by another diagnosis. Migraine with aura requires fully reversible focal neurologic symptoms developing over ≥5 minutes and lasting <60 minutes, followed by headache. Evaluate red flags (e.g., SNOOP10), medication-overuse headache risk, comorbidities, and use a headache diary.
Treatments
- Acute, stratified therapy (NSAIDs/acetaminophen; triptans; gepants; antiemetics)
- Preventive pharmacotherapy (beta-blockers, topiramate, amitriptyline, valproate/divalproex) for ≥4 monthly migraine days or significant disability
- CGRP-targeting monoclonal antibodies for prevention (erenumab, fremanezumab, galcanezumab)
- OnabotulinumtoxinA for chronic migraine (PREEMPT protocol)
- Noninvasive neuromodulation (external trigeminal nerve stimulation, noninvasive vagus nerve stimulation)
- Behavioral therapy (biofeedback, CBT, PMR), sleep and lifestyle optimization, trigger management
Medications
- Acute: NSAIDs (ibuprofen, naproxen), acetaminophen, triptans (sumatriptan, rizatriptan, zolmitriptan, eletriptan, almotriptan, naratriptan, frovatriptan), gepants (ubrogepant, rimegepant), antiemetics (metoclopramide, prochlorperazine), sumatriptan/naproxen combination
- Preventive: beta-blockers (propranolol, metoprolol, timolol), topiramate, divalproex sodium/valproate (avoid in pregnancy), amitriptyline, venlafaxine
- CGRP monoclonal antibodies: erenumab, fremanezumab, galcanezumab
- OnabotulinumtoxinA (Botox) for chronic migraine
Limitations
- Variable individual response; some patients remain refractory. - Triptans contraindicated in significant cardiovascular/cerebrovascular disease; valproate teratogenic; topiramate cognitive/paresthesia side effects. - CGRP mAbs and gepants can be costly or restricted by payers; long-term safety is favorable but still accruing. - Medication-overuse headache risk with frequent acute drug use; requires education and limits. - Pregnancy/lactation constrain pharmacologic options; requires tailored plans. - Neuromodulation device access/cost and variable insurance coverage.
Sources
- Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38(1):1-211.
- AAN. Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults. Neurology. 2012;78:1337-1345.
- American Headache Society (AHS) Consensus/Position Statements on integrating new migraine treatments and CGRP-targeting therapies. Headache. 2019–2021.
- AHS Evidence assessments for acute migraine therapies (triptans, NSAIDs, gepants). Headache. 2015–2021.
- Ubrogepant ACHIEVE I/II: JAMA. 2019;322(19):1887–1898.
- Rimegepant for acute treatment: Lancet. 2019;394:737–745; prevention: N Engl J Med. 2021;385:695–706.
- Erenumab STRIVE: N Engl J Med. 2017;377:2123–2132.
- Fremanezumab HALO: N Engl J Med. 2017;377:2113–2122.
- Galcanezumab EVOLVE-1/2: JAMA Neurol. 2018;75:1080–1088.
- OnabotulinumtoxinA PREEMPT 1/2: Cephalalgia. 2010;30:793–803; Headache. 2010;50:921–936.
- External trigeminal nerve stimulation (Cefaly) PREMICE: Cephalalgia. 2013;33:816–827.
- Noninvasive vagus nerve stimulation (gammaCore) PRESTO: Cephalalgia. 2018;38:959–969.
Eastern & Traditional Medicine
Acupuncture (TCM-informed)
Pattern-informed body and auricular acupuncture to regulate qi/blood, calm liver yang, and modulate pain pathways. Often used preventively 1–2 sessions/week for 6–8 weeks, then tapered; electroacupuncture sometimes used for refractory cases.
Techniques
- Manual body acupuncture (e.g., GB20, LI4, LR3, ST8, Taiyang) individualized to pattern
- Electroacupuncture for prevention
- Auricular acupuncture/ear seeds
- Adjunctive moxibustion or cupping in selected patterns
Traditional Chinese Medicine (pattern-based herbs and lifestyle)
Differentiates migraine into patterns such as liver yang rising (temporal throbbing, irritability), blood stasis (fixed, stabbing pain), or phlegm-dampness (heavy, distending pain, nausea). Treatment aims to subdue liver yang, move blood, and transform phlegm; diet and sleep regularity are emphasized.
Techniques
- Herbal formulas tailored to pattern (e.g., Tian Ma Gou Teng Yin for liver yang; Xue Fu Zhu Yu Tang for blood stasis; Ban Xia Bai Zhu Tian Ma Tang for phlegm-damp)
- Chai Hu Shu Gan San for stress-related patterns
- Lifestyle guidance (regular meals, sleep, stress modulation)
Ayurveda
Migraine is often associated with vata-pitta aggravation (Ardhavabhedaka/Sooryavarta). Management combines shodhana/shamana approaches with local head/neck therapies, diet, daily routines, and stress reduction to restore doshic balance.
Techniques
- Nasya (medicated nasal oils/ghee) under supervision
- Shirolepa (herbal pastes applied to scalp/forehead)
- Shirodhara/abhyanga (in select cases)
- Diet/lifestyle aligned with prakriti and migraine triggers
Behavioral medicine (biofeedback, PMR, CBT)
Targets autonomic dysregulation, muscle tension, and stress reactivity. Often combined with pharmacotherapy; can reduce attack frequency and disability and is useful when medications are limited (e.g., pregnancy).
Techniques
- Thermal and EMG biofeedback
- Progressive muscle relaxation and diaphragmatic breathing
- Cognitive-behavioral therapy for pain coping and trigger management
Sources
- Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016;(6):CD001218.
- Vickers AJ et al. Acupuncture trialists’ collaboration meta-analyses: sustained effects and migraine subgroup findings. Arch Intern Med. 2012;172:1444–1453.
- Zhao L et al. Comparative effectiveness of TCM herbal formulas for migraine: systematic reviews/meta-analyses (varied quality). Complement Ther Med. 2015–2020.
- Chinese Pharmacopoeia and classical sources for pattern/formula selection (traditional evidence).
- Tiwari S. Ayurvedic management of Ardhavabhedaka: classical texts and contemporary case series. AYU. 2011–2018.
- WHO Benchmarks for Training in Ayurveda. 2010.
- AAN Guideline: Behavioral and physical treatments for migraine prevention in adults. Neurology. 2012.
- Nestoriuc Y, Martin A. Biofeedback for headache disorders: meta-analysis. Appl Psychophysiol Biofeedback. 2007;32:105–115.
Integrative Perspective
- Acupuncture has among the strongest evidence of any complementary therapy for migraine prevention and can be combined with standard care to reduce monthly migraine days and medication use. - Magnesium (400–600 mg/day, often citrate or glycinate) and riboflavin (400 mg/day) have guideline support, are generally well tolerated, and pair well with pharmacologic prevention. - Butterbur (Petasites hybridus) previously showed efficacy for prevention, but safety concerns about pyrrolizidine alkaloids (PA)—hepatotoxic and potentially carcinogenic—led to guideline withdrawal of recommendations in many regions. If considered, only certified PA-free extracts should be used, with liver safety monitoring; many clinicians now avoid butterbur. - Feverfew (standardized extract such as MIG-99) has mixed-to-moderate evidence; consider trial if patients prefer botanicals and are not pregnant (possible uterine effects). Monitor for mouth ulcers/gi intolerance and drug interactions. - Combine behavioral therapy (biofeedback/PMR) or yoga with medication for additive benefit; emphasize sleep, regular meals, hydration, and aerobic activity. Educate on limits for acute medications to prevent medication-overuse headache. - Match preventive choice to comorbidities (e.g., beta-blockers for hypertension/anxiety; amitriptyline for insomnia; topiramate for obesity; avoid valproate in women who could become pregnant). Consider neuromodulation (Cefaly, gammaCore) when medications are poorly tolerated or contraindicated.
Sources
- Headache Classification Committee of the IHS. ICHD-3. Cephalalgia. 2018.
- AAN. Pharmacologic prevention guideline. Neurology. 2012.
- AHS Consensus/Position Statements on acute and preventive treatments and CGRP-targeting therapies. Headache. 2019–2021.
- Ubrogepant ACHIEVE I/II. JAMA. 2019.
- Rimegepant acute (Lancet 2019) and prevention (NEJM 2021).
- Erenumab STRIVE (NEJM 2017); Fremanezumab HALO (NEJM 2017); Galcanezumab EVOLVE (JAMA Neurol 2018).
- OnabotulinumtoxinA PREEMPT (2010).
- Cefaly PREMICE (Cephalalgia 2013); gammaCore PRESTO (Cephalalgia 2018).
- Acupuncture Cochrane Review (Linde et al., 2016).
- AAN/AHS complementary therapies guidance: magnesium, riboflavin, feverfew, butterbur (with 2015 safety advisory on butterbur/PA).
- Diener HC et al. MIG-99 feverfew RCT. Cephalalgia. 2005;25:1031–1041.
Health Disclaimer
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.