Non-pharmacological treatment of Migraine · treatment of Migraine Pete Miller Exeter Headache...
Transcript of Non-pharmacological treatment of Migraine · treatment of Migraine Pete Miller Exeter Headache...
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Non-pharmacological
treatment of Migraine
Pete Miller
Exeter Headache meeting 2017
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Non pharmacological management
Weight loss
Diet
Riboflavin, Magnesium etc
Neuromodulation
Acupuncture
Mindfulness
CBT and neurofeedback
Physical therapies
Homeopathy
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Weight loss
Migraine associated with obesity and metabolic syndrome
Increased risk chronic migraine
Inflammatory mediators –adipocytokines
2 small studies – bariatric surgery reduction in frequency and disability; helped in children
One prospective study in adolescents- helped but multiinterventional
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Diet
Low sodium - DASH
Low fat – 12 week
max 20g/ day study
Elimination – children ( unselected ags helped; amines didn’t )
Adult – histamine free
Adult- igG response
Ketogenic diet change in neuronal excitability and reduction of CSD in short term
1928; 1930s 78% response
Studies compared to low calorie diet show benefit
High fat/ low CHO/ controlled protein
Low sucrose
Tryptophan reduced
High omega-3 cf 6
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Neutriceuticals
Mg CoQ10
Riboflavin Feverfew
PUFAs
Butterbur
RIBOFLAVIN
Oxidation-reduction reactions
Mitochondrial energy depletion
Several open label studies; = propranolol 6 months in one
Well tolerated
Not as clear in children
Helped adolescents with chronic migraine
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Acupuncture
Traditional more than western
Several reviews
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Neuromodulation
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Transcranial magnetic stimulation
TMS
Fluctuating magnetic field
ionic current
Single , repetitive, low / high
frequency
Cerena / Spring
Acute and preventative
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Vagal Nerve stimulation
nVMS
Acute 65% reduction
EVENT – chronic migraine
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Supraorbital nerve stimulation
STS
Cefaly
PREMICE trial 6.9 days to 4.8 days
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Other neuromodulation
Other
Non- invasive
Direct current
Mastoid Caloric
Invasive
ONS Spheno-palatine
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Mindfulness
Intentional, non-judging mental awareness; curiosity, openness and acceptance
Non-judgemental attitude towards internal sensations to make intentional choices
MBSR, MBCT, DBT, ACT ……
Studies in chronic pain
Sun, Kuo, Chiu – accidental headache
Maybe some direct physiology effects
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Physical Therapies
Spinal
Soft tissue
Exercises
biofeedback
TENS
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Physical therapies
More effective in TTH overall?
Spinal manipulation/ mobilization : less in TTH ; ? Migraine ( conflicting ); more likely cervicogenic
10% side effects unpreventable?
Soft tissue therapies- for TTH?Recent metaanalysis shows multimodal manual therapies may help
CeH – sternocleidomastoid trigger points
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Physical Therapies
Exercises
Exercise-induced hypo-analgesia
related to activation of
descending inhibitory pathways
Aerobic exercise helps in migraine
Therapeutic exercises help TTH
and CeH : deep neck flexors
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Physical Therapies
TENS
TENS ? Can help TTH, migraine
and CeH but “poor
methodological rigor” means
hard to interpret
Bowen?
Biofeedback
Two meta-analyses show reduced
sensitivity and frequency in TTH
and migraine
Neurofeedback combines
behavioural techniques and
neurophysiological recordings to
control aspects of brain activity
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Homeopathy