Alternative Treatments for Migraine: A Research Update

There is building excitement for new calcitonin gene-related peptide (CGRP) antibodies that may serve as good preventive treatments for headaches and migraines, but outside of this, there have not been many new medical innovations for the pharmaceutical treatment of headache and migraine.

With a lack of development in the lab, much attention has been put on complementary treatments for the relief of headache.

An article recently published in the Journal of Headache and Pain by Giorgio Lambru, MD, and colleagues reviewed the efficacy of high frequency spinal cord stimulation in chronic refractory primary headaches.¹ The study included 7 patients who had some form of refractory chronic headache and were nonresponsive to several conventional medications as well as Botulinum toxin type A. Participants underwent a 2 week trial of the procedure, in which they had 1 or 2 leads placed in the epidural space in the thoracic region that was connected to an external stimulator, targeting the dorsal columns in the C2-3 vertebral level. After a two week trial period, leads were planted permanently if the trial was considered successful.

Four of the chronic migraine patients were considered to have a successful trial period, in which they had at least a 50% decrease in headache intensity or frequency. The researchers noted that all of these patients were thought to be overusing medication at the time. Two of the patients were also taking a daily preventive medication for their chronic headaches.

The patients were followed up with from 12-40 months after the procedure. All participants noticed improvements, with at least a 50% decline in the monthly number of headaches as well as decreased number of days of which they needed to take an abortive or pain medication. One of the patients was also able to stop using his preventive treatment. All the patients were given continuous stimulation and patients noticed worsening when they were turned off. There were no major side effects, except worsening of headache pain, which was thought to be due to a lead malfunction.

Two patients with SUNA-syndrome also had leads implanted. One of the patients described 70% relief while the other reported complete relief of attack, although initially the right settings needed to be found for the implant. One patient with cluster headache who also had leads implanted reported approximately 50% relief.

Overall, this seems like a promising treatment for patients with refractory chronic headaches and for those with a variety of underlying primary headaches. It is thought to work by modulating the trigeminocervical complex in the dorsal columns at the level of C2-3 vertebral bodies. This mode may have advantages over occipital nerve stimulators, including a more rapid response and lower risk of side effects.

Another complementary technique that has recently shown promising results is noninvasive neurotechnology that uses sound to help with migraines. The method may also help with blood pressure and heart rate variability.² This technique was presented in a session as part of the American Heart Association’s Council on Hypertension 2016 Scientific Sessions. Called high-resolution, relational, resonance based, electroencephalic mirroring (HIRREM®), it uses sensors that measure electrical activity in the brain to detect differences between the 2 hemispheres.  Presenting researcher Hossam A. Shaltout, RPh, PhD, Wake Forest University in Winston-Salem, North Carolina believes that imbalance between the 2 sides of the brain may be a result of autonomic dysregulation due to chronic stress. The brain activity is reflected as audible tones which allow for regulation and balance between the 2 sides.

In one study (Abstract P602), the researchers examined the effect of HIRREM on 52 adults who had reported they suffered from migraines. After almost 16 sessions, patients noticed that there was an improvement in headaches as well as mood and insomnia. Although this is in preliminary phases, it may be a potential complementary treatment for patients with headaches with little risk of adverse effects.

Another group of researchers recently conducted a systematic review of evidence for the use of acupuncture in headache and migraine treatment. The study, published in Headache Journal, included nearly 5000 patients from 22 studies that compared acupuncture treatment for at least 8 weeks with other migraine prophylaxis.

The results revealed at least a 50% reduction in headache. The authors concluded that there was a significant improvement in headache frequency when compared to either routine care or prophylactic drug treatment at 2 months, although findings were not consistent in longer periods. They did still consider acupuncture to be a viable option for treatment of migraine in patients who did not tolerate or do well with prophylactic medications.There were similar findings for the use of acupuncture for tension type headaches and chronic headaches. Given its low risk of side effects, it would be a good option for patients who have tried traditional medications or as an adjunct to help treat headaches.

Finally, a review conducted by Todd Schwedt, MD and Bert Vargas, MD showed that neurostimulation may be useful as an adjunct to conventional headache and migraine therapies.⁴ These include transmagnetic stimulation, which is FDA approved for the treatment of migraine with aura, along with transcutaneous supraorbital nerve stimulation.

Transcranial magnetic stimulation has been shown to be effective in treating multiple conditions in both chronic and episodic migraine.⁵ In addition to neurostimulation or neuromodulation, these other types of noninvasive techniques for migraine may also prove to be effective.

In a time where there are only a few conventional therapies for migraine, many of which are not preferable to patients due to adverse effects, these complementary or adjunct therapies may prove to be useful.

References

1. Lambru G, Trimboli M, Palmisani S, Smith T, Al-Kaisy, A. Safety and efficacy of cervical 10 kHz spinal cord stimulation in chronic refractory primary headaches: a retrospective case series. J Headache Pain.  2016;(17)66: 2-8.
2. How “brainwave-balancing” therapy could ease migraines. Wake Forest School of Medicine. Last updated September 15, 2016. Accessed October 3, 2016.
3. Coeytaux RR, Befus D. Role of acupuncture in the treatment or prevention of migraine, tension-type headache, or chronic headache disorders. Headache. 2016;56(7):1238-40.
4. Schwedt TJ, Vargas B. Neurostimulation for treatment of migraine and cluster headache. Pain Med. 2015;16(9):1827-30.
5. Bhola R, Kinsella E, Giffin N, et al. Single-pulse transcranial magnetic stimulation (sTMS) for the acute treatment of migraine: evaluation of outcome data for the UK post market pilot program. J Headache Pain. 2015;16(51):1-8.