Department of Neurology, Wake Forest Baptist Health, Winston-Salem, NC, USA.
Curr Pain Headache Rep. 2019 Feb 21;23(2):10. doi: 10.1007/s11916-019-0750-8.
The purpose of this review is to evaluate evidence from the last 3 years on complementary and integrative medicine treatment options for episodic migraine. Using Pubmed, Embase, and Cochrane databases, research published from 2015-2018 evaluating the modalities of mind/body therapies, supplements, and manual therapies for treatment of migraine were assessed.
Although many studies had major methodological challenges that limit interpretation, several studies reported decreased headache frequency, improved quality of life, or less affective responses to pain. The evidence is currently most promising for the mind/body treatment options of mindfulness, yoga, and tai chi. Mindfulness meditation may be as effective as pharmacological treatment for medication-overuse headache after the offending medication is withdrawn. While older research has shown magnesium, riboflavin, feverfew, and butterbur to be helpful in migraine treatment, new research is promising to suggest potential benefit with melatonin, vitamin D, higher dosages of vitamin B (80 mg)/folic acid 5 mg combinations, and the combination of magnesium 112.5 mg/CoQ10 100 mg/feverfew 100 mg. Omega 3s have limited evidence of efficacy in migraine. Butterbur needs to be free of pyrrolizidine alkaloids (PA) to ensure safety given their hepatotoxicity. Physical therapy (PT) continues to have strong evidence of support, and acupuncture is superior to sham acupuncture and placebo. Side effects and risks reported were minimal and well tolerated overall, with the exception of the life-threatening risk of cervical artery dissection with high-velocity chiropractic manipulation and hepatotoxicity with the PAs in butterbur. Several studies are ongoing to further evaluate mindfulness, melatonin, PT, exercise, chiropractic manipulation, and acupuncture. The American Academy of Neurology (AAN) and American Headache Society (AHS) are currently updating the guidelines for integrative treatment options for migraine, so additional recommendations may be available soon. In conclusion, many complementary and integrative treatment options may be helpful for patients with migraines, and understanding potential efficacy, benefits, and risks can help providers discuss these modalities with their patients. Such a conversation can empower patients, build the therapeutic relationship, and increase self-efficacy, thus improving outcomes and patient-centered care.
本综述旨在评估过去 3 年有关补充和整合医学治疗偶发性偏头痛选择的证据。通过使用 Pubmed、Embase 和 Cochrane 数据库，评估了 2015 年至 2018 年期间发表的评估身心疗法、补充剂和手动疗法治疗偏头痛的模式的研究。
尽管许多研究存在限制解释的重大方法学挑战，但几项研究报告称头痛频率降低、生活质量改善或对疼痛的情感反应减轻。目前，身心治疗方法（如正念、瑜伽和太极）的证据最有希望。在停用致药物过度使用性头痛的药物后，正念冥想可能与药物治疗一样有效。虽然早期研究表明镁、核黄素、小白菊和贯叶连翘在偏头痛治疗中有效，但新的研究表明，褪黑素、维生素 D、高剂量维生素 B（80mg/叶酸 5mg 联合）和镁 112.5mg/辅酶 Q10 100mg/小白菊 100mg 的联合治疗可能有潜在益处。ω-3 脂肪酸在偏头痛中的疗效证据有限。由于其肝毒性，贯叶连翘必须不含吡咯里西啶生物碱（PA）以确保安全。物理疗法（PT）继续有强有力的支持证据，针灸优于假针灸和安慰剂。总的来说，除了高速度脊椎按摩疗法引起的颈椎动脉夹层和贯叶连翘中的 PA 引起的肝毒性的生命威胁风险外，报告的副作用和风险很小且耐受性良好。目前正在进行多项研究以进一步评估正念、褪黑素、PT、运动、脊椎按摩疗法和针灸。美国神经病学学会（AAN）和美国头痛协会（AHS）目前正在更新偏头痛整合治疗选择的指南，因此可能很快会有更多的建议。总之，许多补充和整合治疗选择可能对偏头痛患者有帮助，了解潜在的疗效、益处和风险可以帮助医生与患者讨论这些方法。这样的对话可以赋予患者权力，建立治疗关系，提高自我效能，从而改善结果和以患者为中心的护理。
