Complementary and alternative treatments for migraine

Patients love complementary and alternative treatments! Most colleagues spend a significant amount of time discussing the benefit and the risk of these therapies. Fortunately, there is scientific evidence for or against the efficacy of several such therapeutic approaches. Knowing the evidence helps to facilitate the therapeutic process, especially when dealing with patients with chronic headache. Behavioral approaches, such as cognitive behavior therapy, relaxation techniques, and biofeedback, are supported by evidence (which is partly outdated), but require a significant amount of time. Physiotherapy and aerobic exercise may be effective to treat headaches and interestingly, the latter also seems to work in depression. The evidence for hypnosis is lacking, possibly for methodological reasons. Homeopathy was shown not to be effective in headaches. There is no convincing evidence for the efficacy of spinal manipulation. There is growing evidence that acupuncture is efficacious; however, there seems to be no difference to sham acupuncture. For several vitamins and supplements, as well as herbal remedies, there is evidence from small, randomized controlled trials. A major problem is that traditional and statistically powerful trial designs cannot be applied in quite a number of complementary and alternative treatments. The best way to treat patients with headache is most probably a tailored approach with a combination of both, conventional and complementary treatment, resulting in a multimodal migraine management.