Holistic Migraine Therapies as Integrative Treatment: Q&A with Deena Kuruvilla, MD

Dr. Kuruvilla wants to remind healthcare providers that holistic therapies have a place in migraine treatment, but they should not be trusted as the sole course of action

Holistic medicine is one of the routes that patients with migraine often take when seeking treatment for their condition. But none of them have enough evidence to support their use as an exclusive therapy.  We recently spoke with Deena Kuruvilla, MD, assistant professor at the Yale University School of Medicine and chair of the Special Interest Section for Complementary and Integrative Medicine for the American Headache Society, about what role holistic treatments can play in migraine management and how to go about discussing their use with patients.

What are holistic treatments, and which ones are effective for treating migraine?

Holistic treatments—also known as “complementary” or “integrative” treatments—are treatments without enough evidence yet to recommend them as mainstream or traditional treatments. There is some evidence, however, that they could be helpful when used alongside mainstream treatments; some helpful holistic treatments that have evidence in favor of them are mindfulness and meditation, acupuncture, and some nutraceuticals. But it’s important to remember that holistic medicine should never replace traditional medicine.

Are there any risks associated with those treatments?

Yes. Spinal manipulation, for example, is an integrative treatment that could be considered complementary to mainstream treatment, but the evidence is not strong enough yet to support the exclusive use of it without more traditional treatments. Spinal manipulation is associated with side effects such as dizziness, worsening headaches, neck or muscle tightness, and, in some rare cases, stroke.

Nutraceuticals are another treatment to use caution with; some of the vitamins that we recommend as a part of mainstream therapies are not FDA-approved. We have to be careful with what we’re recommending and be very cautious when we proceed with recommending nutraceuticals to patients.

Why do some patients with migraine prefer complementary or integrative approaches over traditional prescription or over-the-counter medications?

There are several reasons why patients proceed with integrative medicine. One of the top reasons I’ve heard from my patients is that they’ve had bad luck with mainstream treatments— they may have had mixed side effects with their prescription medications or procedures they have undergone, so they might turn to integrative medicine.

Another reason is that patients with migraine may not be getting enough help from mainstream treatments; desperation can turn them toward integrative methods of care. There’s also a whole different population of people who may not have even seen a physician yet and would prefer to attempt treating their migraine naturally first. However, what they’re doing on their own could possibly harm them.

How should doctors advise patients on approaching a migraine management plan that incorporates these integrative approaches or these natural treatment options?

I came up with an acronym that can help physicians approach this topic with their patients: CARE.

• C is for “Conventional treatment experience.” What has the patient’s experience been with conventional treatments in the past?
• A is for “Avoid judgment.” Patients may feel like they will be judged if they approach the topic of integrative medicine with their healthcare provider.
• R is for “Review.” Review all integrative approaches, as well as their benefits and their risks, in detail with the patient so they can make an educated decision with their provider.
• E is for “Explain why.” Why does the patient want to consider integrative methods?

Can you speak to the importance of a holistic approach to migraine care?

I think the importance placed on a holistic migraine care approach is very patient-dependent and patient-driven at the moment. Patients are really interested in holistic and integrative care; we see a lot of interest around this particular area of medicine on social media and in the news. I don’t think physicians give integrative medicine as much importance because it’s still mainly an unknown realm with a cultural bias surrounding it. But while I don’t think it’s important among physicians, it may have to become a more important topic, because we know it’s exceedingly important to patients.

That being said, doctors still need to remember that complementary and integrative medicine should only complement traditional and mainstream therapies, and never be used as a solo approach to migraine treatments. There is not enough evidence to support their use in that regard yet.