Non-medication treatment options
Non-medication treatment options
For people who are unable to take medication, for example because of pregnancy or contraindications or intolerance of medications, these may be first-line options.
Non-medication options for migraine include:
- supplements, such as magnesium, vitamin B2 (riboflavin) and co-enzyme Q10
- neuromodulation devices (can be used to treat attacks and for prevention)
- behavioural therapies like cognitive behavioural therapy, relaxation, biofeedback and mindfulness
- regular exercise, such as walking, aerobic exercise and yoga
- acupuncture.
Maintaining a regular routine also helps. The migraine brain likes consistency and routine.
For migraine attacks, non-medication approaches that can help include cold or hot therapy (e.g. ice wraps, cold gel packs or a cold towel applied to the head; wheat bags or a warm bath or shower), rest, massage, ginger (especially for nausea), tiger balm or peppermint oil (applied to the painful areas of the head or neck).
Supplements
While there is ongoing research in the field of migraine treatment, several supplements have shown promise in clinical studies as potential approaches for preventing migraine.
Supplements that have some evidence for use for migraine prevention are magnesium, riboflavin (vitamin B2) and coenzyme Q10 (CoQ10). It’s a good idea to ask your doctor about any type of supplement use, to check for possible interactions with other medications and side effects.
Several other supplements that are sometimes used for migraine come with cautions. Butterbur is a herbal supplement that has been withdrawn from use in some countries because of concerns about damage to the liver. Only formulations that are certified to contain the active ingredient, petasites, and to be free of liver toxins should be taken, and consultation with a doctor is advisable.
Feverfew is another plant extract that isn’t recommended in pregnancy and the evidence for its effectiveness is weak.
Some studies suggest that magnesium supplementation may help reduce the frequency and severity of migraine, especially for people with magnesium deficiency. Magnesium is involved in various biochemical processes that can influence nerve function and blood vessel regulation.
The magnesium citrate formulation is better absorbed than oxide or sulphate. Magnesium can cause soft stools; you may need to try various types of magnesium to see what suits you best. If the magnesium supplement is causing diarrhoea, it’s probably not being well absorbed and is less likely to be effective.
CoQ10 is an antioxidant that plays a role in energy production within cells. Some research has indicated that CoQ10 supplementation may help reduce the frequency of migraine attacks.
Learn more:
- American Headache Society – Evidence-based integrative treatments for headache
- Migraine Strong – Migraine supplements: The big 5 you should know about
- Migraine Strong – Ginger for migraine and headache – what you need to know
- Migraine Again – Magnesium for Migraine Relief: How the Powerful Mineral Can Help Prevent Attacks
- Migraine Again – Science says: Omega-3s can help relieve your migraine pain
- Migraine Strong – The melatonin migraine connection – the facts
Neuromodulation devices
Neuromodulation uses non-invasive electrical currents or magnetic pulses to change the activity of the nerve pathways in the brain. Neuromodulation can help to turn down brain activity involved in migraine pain and decrease the frequency of migraine attacks.
Different types of neuromodulator devices work in various ways, including stimulation of specific nerves (e.g. the trigeminal nerve in the face, the vagus nerve in the neck, or the occipital nerve in the back of the head) or more general stimulation of the brain. Most neuromodulator devices can be used as both acute and preventive treatment.
TENS involves applying low-level electrical currents to the skin in order to stimulate nerve pathways. In migraine treatment, TENS devices are often placed on the forehead or other relevant areas to provide relief.
In New Zealand, one TENS device that is recognised by MedSafe is Qalm, by PainGone, however in late 2024 we were informed PainGone was exiting the NZ market. Mynd Migraine Relief was available in NZ for a short time but is not available to easily purchase in NZ now.
The more well known TENS device Cefaly is not available to purchase in New Zealand but is available from overseas.
Cefaly and Relivion are other examples of TENS devices; however they are not available to purchase in New Zealand.
The vagus nerve is a major nerve that connects the brain to various organs in the body. VNS involves using electrical stimulation to influence vagal nerve activity, which may have a positive impact on migraine symptoms.
GammaCore Sapphire is an example of a vagus nerve stimulation device. GammaCore Sapphire is not widely used in New Zealand, but is available through Medistar Australia. It requires a doctor’s prescription and pricing is around $900 AUD for 3 months, plus GST and shipping.
Remote electrical neuromodulation (REN) is a non-invasive therapeutic approach used for the treatment of migraine headaches.
It’s designed to provide relief from migraine symptoms by stimulating specific nerves in the body using electrical impulses. Nerivio is one example of a REN device. Nerivio is not available in New Zealand.
Learn more
- American Migraine Foundation – Neuromodulation for migraine treatment: An overview
Behavioural therapies
Behavioural therapies are psychological approaches that focus on modifying specific behaviours and patterns of thinking. They’re grounded in the idea that behaviours are learned and can be changed through systematic interventions. These therapies aim to identify and understand problematic behaviours, thoughts, and emotions, then utilise techniques such as reinforcement, conditioning, and cognitive restructuring to promote healthier, more adaptive responses.
Many people find that including one or more of these therapies alongside medication(s) can help to minimise the frequency and intensity of migraine attacks, and may be more effective than medication alone.
CBT is a type of talk therapy that helps individuals identify and change negative thought patterns and behaviours. It can be beneficial for managing stress, reducing anxiety associated with anticipation of a migraine attack and reducing the tendency to catastrophize (imagine the worst) during a migraine attack. All of these can help with migraine attacks.
Biofeedback is a method of training people to control physiological functions, including heart rate, temperature, breathing rate and muscle tension. This is done using sensors that monitor these functions – e.g. a band around the chest to monitor respiration, electrical sensors on muscles to measure muscle contraction, sensors on the finger for temperature, heart rate and blood pulse volume.
Feedback from these sensors is used to track the effectiveness of various interventions that aim to change the body’s responses – increase the temperature of the fingers, for example, or lower the heart rate. Interventions focus on relaxation and calming the system and may include breathing exercises, visualisation, progressive muscle relaxation and meditation.
Mindfulness is a mental practice that involves focusing your attention on the present moment, using an anchor such as the breath, and open monitoring, where thoughts are observed to come and go without judgement. Mindfulness techniques may help some people reduce the frequency and intensity of their attacks through stress reduction and promoting relaxation. It can also help reduce migraine-related anxiety and feelings of fear, helplessness and preoccupation with pain when it occurs.
Meditation has a similar effect. Progressive muscle relaxation can also be part of a mindfulness or meditation practice.
Healthy behaviours for migraine management
Healthy habits such as maintaining a regular sleep schedule, regular exercise, a healthy diet, managing stress through relaxation techniques (e.g. meditation, deep breathing exercises) and staying hydrated may help reduce migraine frequency and intensity.
The SEEDs mnemonic is often used when talking about how people with migraine can manage their migraine disease.
SEEDS stands for:
- S: Sleep.
- E: Exercise.
- E: Eat healthy
- D: Diary
- S: Stress management
It’s also advisable for people with migraine to stop smoking, as the risk of stroke is increased in people with migraine who smoke tobacco.
The migraine brain likes consistency, so keeping a consistent sleep schedule can help manage migraine. This includes going to bed at the same time each night, and waking up at the same time every morning – including weekends.
For some people with migraine, exercise can trigger a migraine attack or make a migraine attack worse. But there is good evidence that regular exercise, such as going for a 30 minute walk each day or yoga, can help to reduce the frequency, severity and duration of migraine attacks.
People with migraine often benefit from eating regular, healthy meals throughout the day and avoiding the fluctuations in blood sugar levels that comes with fasting and irregular eating. Staying hydrated is also important.
Keeping a migraine diary is helpful to ensure you receive an accurate diagnosis and appropriate treatment.
There are a few different migraine apps available or you can print out a headache diary such as this one online at Healthify.
Stress can be a trigger for migraine attacks, so managing stress is important for managing migraine. Find an activity that works for you, such as mindfulness, meditation, breathing exercises, massage, yoga or physical exercise. Relief of stress can also be a trigger, as when a migraine attack comes on in the weekend or on holiday, when released from the stresses of work and regular daily life.
Learn more
- Migraine Again – Self care
- American Migraine Foundation – Staying active with migraine
- American Migraine Foundation – Migraine and self-care
- Migraine and Headache Australia – Self-care and trigger management
- American Headache Society – Evidence-based integrative treatments for headache
- Migraine Strong – Migraine supplements: The big 5 you should know about
- American Migraine Foundation – Neuromodulation for migraine treatment: An overview
- American Migraine Foundation – Integrative and complementary migraine treatments
- Migraine Strong – Ginger for migraine and headache – what you need to know
- Migraine Again – Diet and nutrition
- Migraine Again – Alternative therapy
- Migraine Again – Science says: Omega-3s can help relieve your migraine pain
- Migraine Strong – The melatonin migraine connection – the facts
- American Migraine Foundation – Alternative treatments for migraine
