If you have frequent migraine attacks, you’re all too familiar with the throbbing headaches that can wreak havoc on your day. Medications ease the pain for many, but they can sometimes be ineffective or overused or cause unpleasant side effects. That’s where nondrug treatments could come into play.
For some of these therapies, there's scientific evidence that they can be effective. What’s more, you can generally use them along with migraine medicines for even better results.
What Are Neuromodulation Devices?
Devices that deliver electrical or magnetic stimulation to certain nerves or areas of your brain can help treat and prevent migraines. These neuromodulation devices modulate, or change, activity in your brain to stop pain signals. While they don't work for everyone, they're thought to be safe and cause few side effects.
Several types are available, such as:
- External trigeminal nerve stimulation (ETNS). Using electrical impulses transmitted through an electrode, this therapy gently stimulates a nerve along your forehead called the trigeminal nerve. Some studies suggest an hour of treatment with ETNS can significantly improve headache pain for people with migraine. Regular use may help to prevent migraine attacks. You can get an ETNS device without a prescription and use it at home. But talk to your doctor before you try one.
- Transcranial magnetic stimulation (TMS). These devices use magnetic fields to stimulate nerve cells in your brain via a coil placed on your scalp. Research shows that TMS may relieve pain and reduce the frequency of migraine attacks. You need a prescription for a TMS device. You can get these treatments in a doctor's office or with devices you use at home.
- Vagus nerve stimulation (VNS). These devices, applied to the side of your neck, deliver electrical impulses to your vagus nerve. This long nerve regulates many body functions, like mood, heart rate, digestion, and immune responses. Studies suggest VNS may lessen migraine pain and also prevent future attacks. You'll need a prescription for VNS therapy. But one handheld device lets you can do the treatments yourself.
- Implantable occipital nerve stimulation. This kind of device, which a surgeon implants at the base of your skull, sends electrical pulses to your occipital nerve. The therapy works to prevent headaches for some, but not all, people with migraine. One study found it was effective in a little less than half of those who used it.
- Remote electrical neuromodulation (REN). You wear a REN device on your upper arm. You use a phone app to control the device, which targets part of your nervous system that’s involved in pain control. Some studies show it can lessen migraine pain within a couple of hours.
- Multi-channel brain neuromodulation. You get this therapy via a device you wear as a headset. It targets six branches of the occipital and trigeminal nerves in your head. You control it through your smartphone. Studies have shown it can relieve head pain as well as other symptoms like light and noise sensitivity.
What Is Biofeedback for Migraine?
To get biofeedback, you’re hooked up to electrical sensors that measure physical changes in your body, such as your heart rate, temperature, and muscle tension. You use feedback you get from the sensors to help you make changes to better control your body. For example, if you relax certain muscles, you might be able to reduce pain.
Each biofeedback treatment takes about an hour. You may need several sessions over several months. Treatments are available at hospitals, clinics, and physical therapy centers. You can also get biofeedback programs and devices to use at home with your computer or mobile phone, though not all are FDA-approved.
Biofeedback could reduce how often you get headaches, and how serious they are, by 45% to 60%.
How Can Relaxation Training Help Migraine?
For many people, the body's reaction to everyday stresses triggers or contributes to migraine headaches. Relaxation techniques can help you slow down your sympathetic nervous system, which is in charge of your body’s stress response.
In relaxation training, you learn methods to help you relax physically and mentally.
A therapist, such as a psychologist, usually leads the training. It often involves techniques like deep breathing or progressive muscle relaxation (a method in which you tense, then relax, your muscles). You might need several sessions to get the hang of it.
Other relaxation practices, such as yoga and meditation, may also lower your body’s response to stress. One small study found that people who did mindfulness meditation and yoga averaged 1.4 fewer migraine attacks per month.
Acupuncture, Acupressure, and Massage
When you get acupuncture, a trained practitioner inserts small needles into specific spots on your body. This is thought to boost blood flow and endorphins (chemicals your body makes to lessen pain).
In a review study, researchers found that the frequency of headaches dropped by half or more in up to 59% of people who got acupuncture. For some, this benefit lasted for more than 6 months.
To treat migraine, you might need acupuncture once or twice a week for 8-10 sessions. But the number of treatments required varies from person to person.
Other biostimulation treatments that apply pressure to certain points on your body, such as acupressure or massage, help ease both stress and muscle tension. That could, in turn, reduce headaches and improve pain.
Behavioral Therapy to Prevent Migraines
Behavioral therapies teach you skills to manage stress. Some research as shows that these therapies work to reduce the number of migraines you get about as well as preventative migraine medicines.
One type, called cognitive behavioral therapy (CBT), helps you change thought patterns and behaviors that contribute to migraines. Your therapist might ask you to keep a diary to track your headache triggers.
CBT may involve the use of techniques like biofeedback or relaxation training. It often works best when you use it along with migraine medications.
Can Exercise Prevent Migraines?
Regular exercise has been shown to reduce both the frequency and intensity of migraines. When you exercise, your body releases endorphins, chemicals that act like natural painkillers. Physical activity also lessens stress, a known migraine trigger.
A well-rounded exercise program includes three elements:
- Cardiovascular activities, such as jogging, walking, running, swimming, or cycling
- Strength training, such as weightlifting or body weight exercises
- Flexibility exercises, such as yoga or Pilates
It's not common, but exercise actually triggers headaches for some people. A thorough warmup before workouts can help. And see your doctor so they can make sure you don't have another health problem.
Talk to Your Doctor About Nondrug Treatments
In fact, you should talk to your doctor if you’re interested in trying any new therapy. They understand your condition, symptoms, and medical history, so can tell you about the possible benefits and drawbacks of a particular treatment.
As with any treatment, nonmedication treatments may have side effects or negative reactions that your doctor can explain to you.
Photo Credit: Jon Feingersh Photography Inc / Getty Images
Mayo Clinic: “Migraine,” “Transcranial magnetic stimulation,” “Vagus Nerve Stimulation,” “Occipital nerve stimulation: Effective migraine treatment?” “Biofeedback,”
National Health Service: “Treatment: Migraine.”
The Migraine Trust: "Medical Devices."
American Migraine Foundation: “Alternative Treatments for Migraine,” “Biofeedback and Relaxation Training for Headaches,” “Managing Migraine with Exercise.”
BMJ Open: “Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components.”
Mount Sinai: “Migraine.”
American Headache Society: “Neuromodulation as a Treatment for Migraine,” “Vagus Nerve Stimulation for Migraine and Cluster Headache,” “Cognitive Behavioral Therapy for Migraine: Q&A.”
Cephalalgia: “Acute migraine therapy with external trigeminal neurostimulation (ACME): A randomized controlled trial.”
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery: “Repetitive transcranial magnetic stimulation as a prophylactic treatment in migraine.”
Frontiers in Psychiatry: “Vagus Nerve as Modulator of the Brain–Gut Axis in Psychiatric and Inflammatory Disorders.”
Pain and Therapy: “Occipital Nerve Stimulation in Chronic Migraine: The Relationship Between Perceived Sensory Quality, Perceived Sensory Location, and Clinical Efficacy—A Prospective, Observational, Non-Interventional Study.”
Headache: “Remote Electrical Neuromodulation (REN) for the Acute Treatment of Migraine.”
Pain Medicine: “Real-world Experience with Remote Electrical Neuromodulation in the Acute Treatment of Migraine.”
National Headache Foundation: “Biofeedback Training Techniques.”
Headache: “Meditation for Migraines: A Pilot Randomized Controlled Trial.”
Hartford Healthcare: “Cognitive Behavioral Therapy (CBT) for Headache.”
John Hopkins Medicine: "Brain Stimulation Services."
Medscape: "FDA Clears Neuromodulation Device for Acute Migraine Pain."