By Samuel Mathis, MD, Assistant Professor, UTMB
It is estimated that 75% of all adults have had a headache in the last year and 16% of the US population currently has a headache. Headaches cost the US approximately $22 billion per year in both direct medical costs and indirect costs through lost productivity. Many of our standard therapies have significant costs or side effects associated with them. This is a wonderful opportunity for integrative medicine therapies to help reduce the frequency and severity of headaches.
The first aspect of headache control is prevention through the reduction of triggers. Common triggers include perfumes, stress, weather, alcohol, lights, and poor sleep. Certain medical conditions also increase the risk of headache development. Insomnia, anxiety, depression, arthritis, prior stroke, angina, peripheral artery disease, Vitamin D deficiency, and even gastric ulcers all increase the odds ratio of recurrent headaches (1). Identifying and reducing triggers can significantly improve headache frequency.
The first strategy to help with headaches is through lifestyle changes. Patients should strive to get at least 6-8 hours of quality sleep per night. Taking time to discuss sleep hygiene can be key to improving their nighttime experience. Many times, the removal of a television from the bedroom can significantly improve the quality of sleep. Multiple studies have shown that increased screen time leads to increased frequency of headaches in both children and adults. Other lifestyle strategies that can be helpful include regular physical activity. While exercise may be a trigger, research shows reduced frequency and severity of headaches in individuals who exercise regularly. A graded aerobic exercise program can be a helpful start for many.
Another effective strategy for headaches is proper nutrition. Reduce foods that may trigger a headache (i.e. caffeine, MSG, aspartame, nitrites, cheese, citrus, or tomatoes to name a few). A food diary may be helpful in identifying these triggers. An anti-inflammatory diet has been shown to reduce headache frequency (2). Encourage whole foods with increased plants and decreased processed and high-sugar foods.
In terms of supplements, studies have shown certain supplements can help with headaches. Magnesium is the most studied and has been shown to reduce and stop certain headaches and migraines. A typical dose is 400mg per day taken with or without food. The most common side effect is frequent or loose stools. B Vitamins have also been shown to help reduce the severity of migraines in individuals who are deficient. Vitamin D is also effective at reducing migraine frequency for individuals who have a known Vitamin D deficiency. The herb butterbur has shown possible benefits for headaches. The typical dose of butterbur is 150mg/day, though care should be taken as it may be hepatotoxic in certain populations. Ginger may help with the acute onset of headaches. One study found it as effective as sumatriptan for migraine onset. Feverfew is also commonly used with many combination supplements, though research is mixed on its effectiveness (3).
Stress reduction also plays a role in headache reduction. Mind-body therapies have shown significant improvement for many people (4). A 4-8 session course on biofeedback significantly reduced headache frequency. Biofeedback works by increasing the awareness of the body and actively working to relax tensed muscles, breathing, and heart rate variability. In the same way, meditation also helps with headaches by improving the relaxation response. Studies have found meditation reduces frequency by up to 50% after 20 weeks of mindfulness-based stress reduction meditation training (3).
While there are several electrical stimulation/neurostimulation machines that are advertised for headaches, the research is not clear that this works. Anecdotally, patients may find benefits from them, though they are not typically recommended in my practice. TENS units may be helpful for patients with musculoskeletal causes of tension headaches (3).
Finally, acupuncture can also be helpful for headaches. One study found that acupuncture was just as effective as standard medical therapy for headache prevention and treatment (3). In my own practice, I have found that acupuncture can stop a headache almost immediately and significantly decrease the frequency of migraines. Patients should undergo a trial of 8-12 sessions to see the full benefit. Acupuncture is not curative and may need repeat sessions to maintain results.
Headaches affect almost all individuals in their life. They can be debilitating at times. Many times, prescription medications may not be desired or the best option for these patients. This is where integrative medicine offers an alternative for these patients. While helpful, these therapies do not replace standard treatment but should be used to supplement as needed.
References:
- Buce DC, Reed ML, Fanning KM, et al. Comorbid and co-occurring conditions in migraine and associated risk of increasing headache pain intensity and headache frequency: results of the migraine in America symptoms and treatment (MAST) study. J Headache Pain. 2020;21 (1):23.
- Ghoreishy SM, Askari G, Mohammadi H, Campbell MS, Khorvash F, Arab A. Associations between potential inflammatory properties of the diet and frequency, duration, and severity of migraine headaches: a cross-sectional study. Sci Rep. 2022 Feb 21;12(1):2878.
- Rakel, David, and Vincent Minichiello. Integrative Medicine. Ed. David Rakel and Vincent Minichiello. Fifth edition. Philadelphia, PA: Elsevier Ltd., 2023. Print.
- Sierpina V, Astin J, Giordano J. Mind-body therapies for headache. Am Fam Physician. 2007 Nov 15;76(10):1518-22. PMID: 18052018.