Complementary and Alternative Medicine Use Among US Adults With Headache or Migraine

Results From the 2012 National Health Interview Survey

Yan Zhang, PhD; Jeff A. Dennis, PhD; Matthew J. Leach, PhD; Felicity L. Bishop, PhD; Holger Cramer, PhD; Vincent C. H. Chung, PhD; Craig Moore, PhD(c); Romy Lauche, PhD; Ron Cook, DO; David Sibbritt, PhD; Jon Adams, PhD

Disclosures

Headache. 2017;57(8):1228-1242. 

In This Article

Abstract and Introduction

Abstract

Background Given the safety concerns regarding pharmacological agents, and the considerable impact of headache and migraine on the sufferer's quality of life, many people seek other treatment options beyond conventional medication and care to address their symptoms; this includes complementary and alternative medicine (CAM). Some CAM interventions have shown promising results in clinical trials of headache and migraine management. Nonetheless, there has been little research exploring the reasons for using CAM, and the types of CAM used, among this population.

Objective The study aimed to answer the following questions: (1) Which CAM modalities are used most frequently among migraine/headache sufferers? and (2) What are the self-reported reasons for CAM use among migraine/headache sufferers?

Methods This secondary analysis of data from the 2012 U.S. NHIS (a national cross-sectional survey) examined the use of CAM among migraine/headache sufferers, including the main reasons related to CAM use. Data were weighted and analyzed using STATA 14.0.

Results The sample of 34,525 adults included 6558 (18.7%) headache/migraine sufferers. Of the headache/migraine sufferers, a substantial proportion (37.6%, n = 2427) used CAM for various conditions; however, CAM use specifically for headache/migraine was much less prevalent (3.3%, n = 216). Of those who used CAM for headache/migraine, about half used CAM in conjunction with prescription (47.8%, n = 100) or over-the-counter medication (55.1%, n = 113). As severity of headache/migraine increased so did the likelihood of using CAM (severe migraine odds ratio [OR] = 2.32; 95% confidence interval [CI]: 1.41, 3.82; both recurring headache/severe migraine OR = 3.36; 95% CI: 2.08, 5.43; when compared to those with recurring headache only). The most frequently used CAM modality among all headache/migraine sufferers (N = 6558) was manipulative therapy (22.0%, n = 1317), herbal supplementation (21.7%, n = 1389) and mind-body therapy (17.9%, n = 1100). The top 3 reasons for using CAM for headache were general wellness (28.7%, n = 60/209), improving overall health (26.8%, n = 56/209), and reducing stress (16.7%, n = 35/209).

Conclusions Although CAM is used by many sufferers of headache/migraine, the use of CAM specifically for the treatment of headache/migraine is relatively low in the United States. The study also assesses the key differences of CAM use among headache/migraine sufferers in NHIS 2012 compared with those in NHIS 2007, and identifies shortfalls in the evidence-base of several CAM modalities used by U.S. adults for headache/migraine. This information may assist health providers and consumers in making informed decisions about the safest and most appropriate approach to managing headache/migraine.

Introduction

Migraine and other recurrent headache disorders are a common and major public health problem. Headache disorders are one of the most common neurological disorders, with a general prevalence of approximately 50% among adults globally.[1] The lifetime prevalence of migraine is 14%, reaching 46% for tension type headache.[2] According to the 2012 National Health Interview Survey (NHIS), 13.8% of U.S. adults aged 18 years or older reported having migraine or severe headache in the previous 3 months.[3]

Migraine and headache disorders are prominent causes of personal suffering and decreased economic productivity. The burden of the disorder is substantial because of the high prevalence, accompanying significant disability, and risk for other comorbidities. Headache is among the top 20 reasons for outpatient medical visits and the top 5 reasons for emergency room visits in the USA.[4] In addition, over 12 million office visits for migraine occurred in 2009 in the USA, and over 6 million prescriptions were issued for antimigraine drugs, indicating that roughly half of all outpatient visits for headache result in the prescription of an antimigraine agent.[4]

Pharmacological agents constitute an important part of conventional medical management of headache and migraine.[5,6] Although many patients report benefits from these treatments, pharmacological therapy does not work for all patients, with many failing to achieve optimal control of the disorder or experiencing undesirable side effects from the use of these pharmacological interventions.[5] For instance, amitriptyline – one of the most widely used preventive antimigraine agents – is associated with several unpleasant side effects ranging from drowsiness, dry mouth, constipation, and weight gain, to precipitation of cardiac arrhythmias, seizures, or exacerbation of closed-angle glaucoma.[5] Although many patients may turn to over-the-counter (OTC) conventional medications such as acetaminophen for the relief of symptoms, prolonged or frequent use of such OTC medication is not recommended by the American Headache Society due to concerns regarding long-term use,[7] including the increased risk of liver damage and gastrointestinal bleeding.[8,9]

Given the safety concerns around these pharmacological agents, and the considerable impact of headache and migraine on the sufferer's quality of life,[10] it is not surprising that many people seek other treatment options beyond conventional medication and care to address their symptoms; options that include complementary and alternative medicine (CAM). Some CAM interventions, including acupuncture,[11,12] mind-body therapies,[13] and spinal manipulation,[14,15] have shown promising results in clinical trials of headache and migraine management.[16,17]

The findings of one review point to a high prevalence of CAM use concurrent to conventional medicine treatment among people with headache and migraine;[18] notwithstanding, there has been little research on the reasons for using CAM, and the types of CAM used, among this population. While an earlier analysis of 2007 NHIS data attempted to shed some light on these parameters,[19] these data are now over 9 years old; further, the study reported CAM use for those who had headache/migraine within a relatively short period of CAM use (ie, previous 3 months). As such, there remains a gap in the contemporary understanding of CAM use for headache and migraine as well as the prevalence of CAM use among those who reported having headache/migraine over a more extended time period. The study reported in this paper addresses these gaps by analyzing 2012 NHIS data to describe CAM use among all migraine/headache sufferers in the previous 3 and 12 months, as well as examining the characteristics and factors related to CAM use. The objectives of this study were to: (1) describe the CAM modalities that are used most frequently among migraine/headache sufferers; and (2) explore the self-reported reasons for CAM use for migraine/headache sufferers.

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