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Alternative Headache and Migraine Therapies
Migraine patients
have several alternative headache and migraine interventions available
as adjuncts to, or sometimes substitutes for, traditional
medications. Among these nonpharmacologic or nontraditional
headache treatments are biofeedback, acupuncture, Botox injections,
and topical Lidoderm patches.
The first two options involve no chemicals at all; the latter
two options are non-FDA approved for purposes of migraine,
but have proven clinically successful for a significant percentage
of patients. Of the latter two interventions, Botox injections
are undergoing studies in efforts to gain FDA approval and
insurance coverage for headache treatment of both migraine
headache and tension-type headache. The nonpharmacological
treatments, as well as Lidoderm patches, are excellent options
for the patient who wants to minimize systemic exposure to
drugs. This includes pregnant patients, children, the elderly,
and those with numerous systemic allergies to medications.
Let us discuss these four alternative headache options briefly:
Biofeedback is the least invasive of the alternative headache
treatments. Simply put, biofeedback involves one or more techniques
to control ones autonomic (unconscious, automatic) body responses
to stress. These are body responses such as blood pressure
changes, or unconscious muscle tension, or changes in heart
rate - and are not necessarily functions one would think are
under one's conscious control. Using instant feedback from
computer monitored instruments or skin thermometers etc.,
a patient can learn to gauge and control his or her automatic
or autonomic body responses. With imaging techniques, for
example, patients can learn to perform hand warming by actually
dilating blood vessels in the hand. Theoretically, this shunts
blood from dilating blood vessels around the migrainous brain
and may successfully abort a pending vascular headache. It
is probable the mechanism of avoiding a migraine with biofeedback
is a lot more complicated than simply shunting blood from
one body part to another. It may involve, at some level, autohypnosis.
In any event using both thermoregulation techniques and muscle
tension control, (using computer monitored electrodes placed
on various muscle groups, i.e., jaw, neck, forehead, etc.)
biofeedback can decrease frequency and/or duration and/or
intensity of headaches in about 30% of our headache patients
who master it. We find biofeedback an especially useful tool
in children with migraines.
Acupuncture derives from traditional Chinese medicine. Acupuncture
involves fine needle insertions at "classical points"
along the body described as meridia. In traditional Chinese
medicine, the meridia are believed to follow patterns of energy
flow in the patient’s body called Qi. In terms of Western
medicines explanation of the benefits of acupuncture, it may
be that these well-placed needles can cause the release of
certain natural neuropeptides/enkephalins, beta-endorphins,
etc. that may then bind to opioid receptors in the central
nervous system. Opioid receptors are at nerve endings that
respond to pain-reducing medications like morphine, and they
act to decrease pain. It may also be that peripheral sensory
stimulation, as occurs in acupuncture, may activate nerve
pathways that modulate and hopefully decrease a patient's
awareness of pain. There are different kinds of acupuncture
- some using electrostimulation. Electrostimulation acupuncture
may also work like TENS units - electrically stimulating nerve
fibers that then block or inhibit pain signals from being
carried to the brain. If the pain signal is inhibited, it
cannot be consciously perceived.
Botox is a distillation of botulism toxin, which is a neurotoxin.
Botox injection involves careful injection of dilute Botox
toxin into areas of the forehead and the back of the head
and neck which then cause some chemical denervation that temporarily
alleviates over-contraction of some muscles and may alleviate
tension-type headaches and even migraine. There are several
theories why Botox may help migraine, including the theory
that it may block nerves that then carry pain messages to
the brain or may, in fact, even block certain chemicals that
then contribute to migraine. Again, this is a treatment that
is not yet FDA approved for headache, but has been found clinically
successful in approximately 50% of the patients who try it.
It is unfortunately still very expensive and may not work
for everyone, and generally, even if effective, needs to be
repeated anywhere from three to six months after successful
treatment.
The Lidoderm patch is an adhesive bandage-type of patch that
is impregnated with 5% lidocaine. This is topically absorbed
and currently approved for pain from herpes zoster or shingles.
It may be useful in alleviating or lessening pain of migraines
in patients who experience their pain under smooth skin areas
such as on the forehead, around the cheek or in the neck.
Since the bandage does not adhere to hair-covered areas, it
will not work in patients who experience most of their pain
under their scalp or under an area of hair. The bandage may
be worn up to 12 hours a day and may be useful as an adjunct,
when patients do not want to take oral medication. There are
minimal side effects, if any. It is non-sedating and may be
worth trying in the patient who needs another alternative
treatment for their head pain. Again, this is not FDA approved
and may be very expensive if not covered by insurance.
In summary, although it is difficult to adequately study alternative
headache treatment in controlled double-blind studies, some
of these treatments are anecdotally successful in helping
some headache patients.
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