Alternative Headache Treatments

Nutraceuticals, Behavioral and Physical Treatments

Christina Sun-Edelstein, MD; Alexander Mauskop, MD


Headache. 2011;51(3):469-483. 

In This Article

Abstract and Introduction


There is a growing body of evidence supporting the efficacy of various complementary and alternative medicine approaches in the management of headache disorders. These treatment modalities include nutraceutical, physical and behavioral therapies. Nutraceutical options comprise vitamins and supplements (magnesium, riboflavin, coenzyme Q10, and alpha lipoic acid) and herbal preparations (feverfew, and butterbur). Although controversial, there are some reports demonstrating the benefit of recreational drugs such as marijuana, lysergic acid diethylamide and psilocybin in headache treatment. Behavioral treatments generally refer to cognitive behavioral therapy and biobehavioral training (biofeedback, relaxation training). Physical treatments in headache management are not as well defined but usually include acupuncture, oxygen therapy, transcutaneous electrical nerve stimulation, occlusal adjustment, cervical manipulation, physical therapy, massage, chiropractic therapy, and osteopathic manipulation. In this review, the available evidence for all these treatments will be discussed.


The use of complementary and alternative medicine (CAM) has been on the rise, as demonstrated by epidemiological studies in the USA and Europe over the past few decades.[1,2] More recently, the utilization of CAM has increased in patients with neurological disorders, and now appears to be in widespread use among patients even in tertiary headache care. In a recent questionnaire-based survey conducted in Germany and Austria, the majority (81.7%) of patients attending tertiary outpatient headache clinics reported use of CAM.[3] CAM usage is often motivated by dissatisfaction with conventional therapies and medication side effects, or a desire to be proactive against a disabling disorder.

Although there is no formal definition for CAM, the National Center for Complementary and Alternative Medicine considers it to be "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine."[4] For many patients, the appeal of CAM is in the holistic, empowering, and educational nature of the various treatment strategies. CAM modalities can generally be divided into nutraceutical, physical, and behavioral therapies. In the context of headache treatment, nutraceutical options include vitamins, supplements and herbal preparations, while non-pharmacological therapies include behavioral treatments, physical therapies, and acupuncture. Behavioral treatments usually comprise cognitive behavioral therapy (CBT) and biobehavioral training (biofeedback [BFB], relaxation training).

There is increasing evidence for the efficacy and tolerability of some CAM approaches in the management of headache disorders. Although these strategies may be used instead of traditional medications, using them in conjunction with conventional pharmacological therapies as part of a multidisciplinary treatment plan is more likely to result in optimum responses.[5–7] In this review, the evidence for various CAM therapies in headache treatment will be discussed.


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