Our Take: Alternative Headache Treatments Delight

Bonnie and Steve: a recently published study from journal Headache: Alternative Headache Treatments, Nutraceuticals, Behavioral and Physical Treatments is as exciting a piece on headaches as we have seen.

"According to researchers, 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 nutraceuticals, physical and behavioral therapies." Bonnie and Steve: we have summarized this review and commented on what we feel are the most important parts for our clients and readers.

CAM
The use of complementary and alternative medicine (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. CAM usage is often motivated by dissatisfaction with conventional therapies and medication side effects, or a desire to be proactive against a disabling disorder.

Research
Data from the National Library of Medicine (PubMed), The Cochrane Library, and the American Academy of Neurology's Evidence-Based Guidelines were searched through August 2010 to identify studies, reviews, case series, reports or other information that assessed the alternative treatment of headache or migraine.

Nutraceuticals
The evidence for some nutraceuticals is promising, especially for magnesium.

Magnesium
Essential cation that plays a vital role in multiple physiological processes, may have several roles in migraine pathogenesis. Deficiency in magnesium has been associated with cortical spreading depression, neurotransmitter release, platelet aggregation, and vasoconstriction, all of which are important aspects of our current understanding of migraine pathophysiology. In addition, magnesium concentration influences serotonin receptors, nitric oxide synthesis and release, inflammatory mediators, and various other migraine-related receptors and neurotransmitters. Magnesium also plays a role in the control of vascular tone and reactivity to endogenous hormones and neurotransmitters, through its relationship with the NMDA receptor. Deficiency in magnesium results in the generation and release of substance P, which subsequently acts on sensory fibers, resulting in headache pain.

Given its commercial availability, the red blood cell (RBC) magnesium assay is a good way of assessing for deficiency, as improvements in clinical symptoms correlating with corrected levels would clearly demonstrate the benefits of magnesium supplementation.

Several studies have shown that magnesium supplementation is effective in migraine treatment. In one study, women with menstrual migraine receiving 360 mg of magnesium daily from ovulation to the first day of flow resulted in a significant reduction of the number of days with headache, total pain index, as well as an improvement of the Menstrual Distress Questionnaire score compared to placebo. Two other study comprising migraineurs also showed that attack frequency was reduced by 41.6% in the magnesium group.

The most common adverse effect associated with oral magnesium supplementation is diarrhea. Bonnie and Steve - this is why the glycinate form is so wonderful. It does not cause loose stool.

Several studies have also shown positive results with Intravenous Magnesium treatment. 1 g of magnesium sulfate resulted in rapid headache relief in patients with low serum levels. In another trial of patients with moderate to severe migraine attacks, treatment with 1 g intravenous magnesium sulfate was superior to placebo in terms of both response rate (100% for magnesium sulfate vs 7% for placebo) and pain-free rate (87% for magnesium sulfate and 0% for placebo). Of note, none of the subjects reported headache recurrence during the 24 hours after treatment.

Bonnie and Steve: so...now are you convinced with regards to magnesium?!

The remainder of this piece exploring supplements, behavioral, and physical headache therapies is available to NCI Well Connect subscribers. Click here for a sample issue or to order.