Alternative and Complementary Approaches to Migraine and Cluster Headaches

In the United States, alternative and complementary medicine is growing rapidly and includes treatment of many health conditions, including pain. In 2002, according to a government survey of approximately 31,000 people, more than a third of American adults used such practices. This was the largest study on unconventional medical approaches in the United States. If prayer is included as an alternative form of therapy, then approximately 62% of American adults are using some form of nonconventional treatment.  

Alternative and complementary medicine includes such practices as acupuncture, yoga, tai chi, meditation, herbs, homeopathy, and manipulation, to name but a few. Another term, which reflects the use of these therapies within the concepts of Western medical practice, is integrative medicine. Many physicians who are board-certified in their respective specialties, and who have sought additional training in alternative and complementary care, prefer to use this term because it encompasses the best of both worlds in the overall management of a patient. 
 
Over the last decade, integrative medical practices have increasingly been used for the management of chronic pain. This article provides a general overview of the more commonly used integrative medical approaches for the management of pain, specifically migraine and cluster headache pain.

Migraine pain may be localized to one side of the head, behind the eye, the back of the neck, or about the face. The pain is associated with nausea and sometimes vomiting. Patients become sensitive to light (photophobia) and certain smells (osmophobia). Intermittent dizziness may occur. Some patients, called migraineurs, may develop an “aura,” that is, a feeling that comes on before the headaches begin. These auras may be associated with visual changes, such as spots, tunnel vision, or wavy lines. The headaches may last up to three days and may occur several times per week or as infrequently as once or twice a year. Women are more prone to migraines than men.

Cluster headaches are given their name based on the fact that the attacks of pain occur in clusters that may last several weeks to months. The pain is agonizing and usually affects one side of the face, involving severe pain behind one of the eyes with associated nasal congestion and runny nose. Men tend to get these types of headaches more frequently than women.

Before you seek an alternative approach to your headache pain, make sure that it is correctly diagnosed. Evaluations for your headache may include examinations by your primary care physician, a consulting neurologist, and an ear, nose, and throat specialist. It is important that you have your condition(s) properly diagnosed; if not, any therapy you receive, be it from a Western medical or an integrative approach, will likely not be beneficial. It is essential that all serious, emergent, and urgent causes of your pain are excluded by a traditional medical physician before you try some of the nontraditional approaches.

Spinal manipulation 

Spinal manipulation has been well documented within the writings of Hippocrates and the traditional Chinese medicine (TCM) literature. In Western society, spinal manipulation began in the late 19^th century with the development of osteopathic medicine by a frontier doctor named Andrew Taylor Still, MD. This school of medicine, as he developed it, began in 1874. Today, it has trained osteopathic physicians able to be board-certified in all of the medical and surgical subspecialties within the entire United States. Osteopathic physicians are complete physicians who, in addition to traditional medical and surgical approaches, use osteopathic principles and practice in the management of their patients. Part of their philosophical approach is to recognize that structure and function are interrelated, and their practice includes the judicious use of osteopathic manipulative medicine. These varied techniques attempt to normalize problems within the musculoskeletal system, thereby improving the body’s balance.
 
Another form of manipulation was developed in 1895 by David Daniel Palmer, a local magnetic healer, and a student of Dr Still’s. Palmer termed his healing art “chiropractic,” from the Greek words chiro and praktikos, meaning “done by hand.” Chiropractors are not physicians in the traditional sense of the term. They do not practice medicine or surgery. They do not prescribe medications. Chiropractors treat misalignments, or subluxations, within the spinal column that they believe cause problems within the nervous system, thereby leading to disease. Chiropractors treat these subluxations with manipulation of the spine and may use adjunctive therapies such as heat, electrical stimulation, and ultrasound.
 
Both of these approaches grew and developed their own systems of accreditation. Most patients who receive manipulation today are treated by one of these two groups of healers.
 
The public tends to have a narrow concept of manipulation. High-velocity, low-amplitude techniques, typically referred to by lay persons receiving manipulation as having my “neck cracked,” is the most common perception of cervical manipulative techniques. In fact, within both schools of manipulation, this is far from the truth. The thrusting technique (high-velocity, low-amplitude manipulations) is only one form of therapy that may be used. Other manipulative techniques, such as myofascial release, strain/counterstrain, and muscle energy techniques, may be used instead of the common thrusting procedures. These techniques tend to focus on soft tissue structures.
 
Patients seeking any form of manipulation should do their homework on the proposed providers and techniques used in order to find competent practitioners capable of performing such procedures as safely as possible. The risks and benefits must be clearly discussed. Just as one chooses their surgeon carefully, so too must a patient evaluate any practitioner who would attempt manipulation.
 
Note that no clear study findings within peer-reviewed, evidence-based literature demonstrate that the use of cervical manipulation has any long-lasting effect on the management of migraine or cluster headaches. In addition, the procedure is not without risk. A recent article in the journal Neurology indicated that, although rare, stroke may be a complication of thrusting procedures.
 
Acupuncture, traditional Chinese medicine, and Oriental bodywork
 
Acupuncture and traditional Chinese medicine (TCM) are another form of alternative medical approaches that one may seek for the management of headache pain. The provider of such therapies may be a lay acupuncturist or a physician (MD, DO) who has had additional training in medical acupuncture. Again, it is important for the individual seeking such care to choose the practitioner with whom they would be most comfortable.
 
Acupuncture’s basis derives from the theory that health is governed by a balance of one’s “chi.” Chi, as known within this context, is the life force. It is believed that imbalances within this force may lead to disease. Chi balancing is attempted and maintained by the placement of sterile, disposable needles within regions of the body called meridians. The meridians are a complex network of pathways that circulate the chi throughout the body. Meridian theory is a fundamental concept within TCM, and within acupuncture in particular.
 
Oriental body manipulations within the scope of TCM take a different approach than the Western-based manipulations of osteopathic medicine and chiropractic. These techniques may be part of a comprehensive TCM approach or may be performed completely on their own. They are based on meridian theory, with the attempt to balance the body’s chi through the manipulations being offered. Oriental bodywork may include the following practices:
 

• Tui na
• Jin shin do
• Thai massage
• Shiatsu
• Amma therapy
• Acupressure

Many other techniques are variants or ongoing developments of earlier systems. As always, one should research the therapy being proposed and ask to know the credentials of the providers involved.
 
Homeopathy
 
The practice of homeopathy was developed and founded by German physician Samuel Hahnemann in 1790. The term homeopathy was derived from the Greek homoios, meaning similar, and pathos, meaning suffering. Hahnemann’s fundamental principle, the Law of Similars, noted that if a remedy could mimic the symptoms of a particular disease, it would strengthen the healing response. In simple terms, this concept has been referred to as “like cures like.” Hahnemann developed homeopathic remedies based upon medicinal herbs, vitamins, minerals, and even bee venom. Current practitioners have even made formulations from drugs such as antibiotics.
 
In addition to “like cures like,” Hahnemann developed two other principles by which his system of healing was guided. The first was called the Law of the Infinitesimal Dose, which stated that the more diluted a remedy, the more powerful its effect on treating an illness. The other principle noted that, in order for an accurate assessment to be made, the patient and the illness must be observed on an individual basis because no two individuals respond to the same remedy in the same way.
 
Remedies are formulated based on differing potencies. A remedy’s potency is based upon the concept that a particular substance, an herb for example, is diluted numerous times to achieve a desired effect. The potencies of a particular remedy are expressed in centesimal (c) and decimal (x) scales. Based upon homeopathic theory, lower potencies are used for physical illness, whereas highest potencies are used for mental or emotional problems.

As noted earlier, the headache patient must understand that a proper and accurate diagnosis must be made before entertaining any thoughts of integrative therapies. All serious, emergent, and urgent causes of pain must be excluded by a traditional medical physician before nontraditional approaches are tried. The fundamental healing axiom of “first do no harm” must be a guiding principle whenever an integrative medical provider encounters a patient. Consultations with such providers should be open and honest on both sides. Should the provider or patient withhold clinical information, any attempts of moving forward are fruitless. The provider should make no false promises, and no contracts should be signed or gimmicks offered. If a patient is presented with such a scenario, he or she should not continue seeing that provider.

The patient may need to try differing approaches to their problem. If a particular integrative approach fails, this does not mean that others will have the same outcome. Patience, prudence, and due diligence are needed as one explores these developing approaches.

|Web Links|

American Academy of Medical Acupuncture

American Academy of Neurology
 
American Academy of Osteopathy  

American Chiropractic Association
 
American Osteopathic Association   

Central Westchester Neuromuscular Care, PC
 
National Certification Commission for Acupuncture and Oriental Medicine

alternative medicine, complementary medicine, alternative therapy, nonconventional treatment, acupuncture, yoga, tai chi, traditional Chinese medicine, TCM, Oriental bodywork, meditation, herbs, homeopathy, spinal manipulation, misalignment, subluxation, chiropractic, chiro, chiropractor, integrative medicine, migraine headache, cluster headache, migraineur, neurology, neurologist, primary care physician, first do no harm, alternative and complementary treatments for migraine and cluster headaches

Author: Joseph Carcione Jr, DO, MBA, Consultant in Neurology and Medical Acupuncture, Medical Management and Organizational Consulting, Central Westchester Neuromuscular Care, PC; Medical Director, Oxford Health Plans.

Editors: Robert A Hauser, MD, Director, Parkinson's Disease and Movement Disorders Center, Tampa General Hospital; Professor, Departments of Neurology, Pharmacology, and Experimental Therapeutics, University of South Florida; Mary L Windle, Pharm D, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, .com, Inc; Nicholas Y Lorenzo, MD, Chief Editor, Neurology; Consulting Staff, Neurology Specialists and Consultants.