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Saturday, January 24, 2009

headache - Integrative Therapies

Integrative Therapies
Good scientific evidence:

5-hydroxytryptophan (5-HTP): Supplement use of 5-HTP may help balance serotonin in the body. Serotonin is the brain chemical associated with sleep, mood, movement, eating and nervousness. There is evidence from several studies in both children and adults that 5-HTP may be effective in reducing the severity and frequency of headaches, including tension headaches and migraines. Fewer pain-relieving medications may be needed when taken with 5-HTP; however, many of the available studies show that more proven pharmaceutical drugs may work better than 5-HTP for headaches. Further research is needed. 5-HTP is generally safe when used in recommended dosages. Use with caution if taking antidepressant medications.

Butterbur: Butterbur (Petasites hybridus) is a perennial shrub, found throughout Europe as well as parts of Asia and North America. Pain relief and headache prevention are traditional uses of butterbur. Recent pre-clinical studies suggest anti-inflammatory and vasodilitary (blood vessel opening) properties of butterbur, thereby supporting a possible mechanism of action. A small number of human trials report efficacy of butterbur for migraine prevention when taken regularly for up to four months. This evidence is compelling enough to suggest benefits of butterbur for migraine prevention, although additional evidence from larger, well-designed studies is necessary. The use of butterbur during pregnancy and lactation should be avoided due to a lack of safety studies. Butterbur should not be used if there is an allergy to plants in the Aster family, including ragweed, marigolds, daisies, and chrysanthemums.

Chiropractic: Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health. Manipulation is the skilled, gentle, passive movement of a joint (or spinal segment) either within or beyond its active range of motion. The use of spinal manipulative therapy for the relief of tension or migraine headache has been reported in several controlled human trials and systematic reviews. Overall, the quality of studies is not high, with incomplete reporting of design, inconsistent use of techniques between studies, and variable results. Despite these methodologic problems, overall the evidence suggests some benefits in the prevention of episodic tension headache. Effects on migraine headache have not been demonstrated. Better quality research is necessary in this area before a firm conclusion can be drawn.

Feverfew: Feverfew (Tanacetum parthenium) leaves have long been used orally for the treatment or prevention of headache, and there is a scientific basis for this use. Pre-clinical studies have reported anti-inflammatory and blood vessel dilation (opening) effects. Several controlled human trials have been conducted in this area with mixed results. Overall, these studies suggest that feverfew taken daily as standardized capsules may reduce the incidence of attacks in patients who experience chronic migraine headaches. Feverfew may cause an increase in bleeding and drug interactions. Do not use feverfew if pregnant or nursing, or if allergic to plants in the aster family, including ragweed, marigolds, daisies, and chrysanthemums.

Guided imagery: The term "guided imagery" may be used to refer to a number of techniques, including metaphor, story telling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion using imagery. Therapeutic guided imagery may be used by therapists to help patients relax and focus on images associated with personal issues they are confronting. Initial research suggests that guided imagery may provide added benefits when used at the same time as standard medical care for migraine or tension headache.

Hypnotherapy: Hypnotherapy involves the power of suggestion while the individual is in a deep, relaxed state. Several studies report improvements in severity and frequency of tension headaches following several weekly hypnosis sessions. Early research suggests that hypnosis may be equivalent to other relaxation techniques, biofeedback, or autogenic training.

Unclear or conflicting scientific evidence:

Acupressure: Acupressure, or shiatsu, has been used in China and Japan for thousands of years for health and healing. Self-administered acupressure (in the temple region or others) is reported to help tension or migraine headaches in early studies.

Acupuncture: Acupuncture, or the use of needles to manipulate the "chi" or body energy, originated in China over 5,000 years ago. Although traditionally used to help patients with migraine headaches, there is inconclusive evidence in support of acupuncture for chronic migraine or tension headache. Although the majority of available studies have shown a trend in favor of acupuncture over placebo, most have been small and methodologically flawed. Blinding and follow-up have not been adequate in most studies, and approaches to placebo-control are variable. Larger trials with clear blinding and controls are necessary before a recommendation can be made for or against acupuncture for this indication.

L-arginine: L-arginine, or arginine, is a semi-essential amino acid needed by the body. Arginine is a precursor of nitric oxide, which causes blood vessel relaxation (vasodilation). Preliminary studies suggest that adding arginine to ibuprofen (Advil®, Motrin®) therapy may decrease migraine headache pain. Arginine is generally regarded as safe in recommended dosages.

Coenzyme Q10 (CoQ10): Coenzyme Q10 (CoQ10) is produced by the human body and is necessary for the basic functioning of cells. There is promising good evidence from one randomized and controlled trial and one open label trial to support the use of CoQ10 treatment in migraine prevention or treatment. Properly designed, larger trials of longer treatment duration are needed to confirm these findings. CoQ10 is generally regarded as safe in recommended dosages.

Gamma linolenic acid (GLA): GLA is a dietary omega-6 fatty acid found in many plant oil extracts. One open-label, uncontrolled study has examined the effect of fatty acids, including GLA, on severity, frequency and duration of migraine attacks. Better-designed clinical trials are required before recommendations can be made. Eighty-six percent of patients experienced a reduction in the severity, frequency, and duration of migraine attacks, while 90% of patients had reduced nausea and vomiting. GLA use may increase the chances of bleeding.

Melatonin: Melatonin is a natural hormone that is used for the improvement of sleep patterns. Several small studies have examined the possible role of melatonin in preventing various forms of headache, including migraine, cluster, and tension-type headache (in people who suffer from regular headaches). Limited initial research suggests possible benefits in all three types of headache, although well-designed controlled studies are needed before a firm conclusion can be drawn. Melatonin should not be used for extended periods of time. Caution is advised when taking melatonin supplements as numerous adverse effects including drug interactions are possible. Melatonin is not recommended during pregnancy or breastfeeding, unless otherwise directed by a doctor.

Progressive muscle relaxation: Progressive muscle relaxation involves isolating one muscle group, creating tension for eight to ten seconds, and then letting the muscle relax and the tension go. Individuals can sit (in a comfortable chair), lie on a bed, or lie on the floor (on a comfortable rug or carpet). Muscle groups (including the head, shoulders, arms, hands, stomach, legs, and feet), one at a time, are tensed, then relaxed. This technique has been reported effective in headache prevention, but more studies are needed.

Reflexology: Reflexology involves the application of manual pressure to specific points or areas of the feet that are believed to correspond to other parts of the body. Early research suggests that reflexology may relieve pain from migraine or tension headaches, and that pain medication requirements may be reduced. However, study in this area has not been well designed or reported scientifically, and further evidence is necessary before a firm conclusion can be reached.

Relaxation therapy: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually non-directed relaxation. Most techniques share the components of repetitive focus (on a word, sound, prayer phrase, body sensation, or muscular activity), adoption of a passive attitude towards intruding thoughts, and return to the focus. Preliminary evidence suggests that relaxation techniques may be helpful for the reduction of migraine headache symptoms in adults. Study of relaxation in children with headaches has yielded unclear results. Additional research is necessary before a firm conclusion can be drawn.

Riboflavin (vitamin B2): Several studies suggest benefits of high-dose riboflavin in preventing migraine headaches. Further research is necessary before a firm conclusion can be drawn.

Soy: Soy (Glycine max) is a plant in the pea family (Fabaceae), and is native to southeastern Asia. Soy has been a dietary staple in Asian countries for at least 5,000 years. Soy supplements have been reported to help with symptoms associated with menopause, including headache. One study of a phytoestrogen (plant estrogen) combination showed a reduced number of migraine attacks suffered. Further research is needed. Use of soy supplements may cause drug interactions. Soy should not be used if the patient is pregnant or breastfeeding, unless otherwise directed by a doctor. Until better research is available, it remains unclear if dietary soy or soy isoflavone supplements increase or decrease the risk of developing breast cancer.

Transcutaneous electrical nerve stimulation (TENS): TENS is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Acupuncturists can use TENS by sticking Japanese acupuncture needles into two sites and taping the needles down with surgical tape to prevent them from moving. Practitioners then hook the needles up to a TENS device and an electrical current is applied. The current now travels into the needles, which stimulates points on the body to get the "chi" or energy to flow in a healthy manner. Preliminary controlled trials suggest that TENS may have some benefits in patients with migraine or chronic headache. Additional well-designed research is necessary before a firm conclusion can be reached in this area.

Therapeutic touch (TT): Therapeutic touch practitioners hold their hands a short distance from the patient without actually making physical contact. The purpose of this technique is to detect the patient's energy field, allowing the TT practitioner to correct any perceived imbalances. Therapeutic touch may reduce pain in patients with tension headache, based on preliminary research.

Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Preliminary evidence suggests that yoga may effectively reduce the intensity and frequency of tension or migraine headaches, and lessen the need for pain-relief medications.

Keeping a diary: A diary can help an individual determine what triggers the migraine attack. Writing down when a migraine attack begins, how long each phase lasts, responses to medications, foods eaten in the 24 hours preceding an attack, any unusual stresses before the attack, and how the individual feels and what they were doing when a migraine attack begins is important.

Dietary factors: Identifying and avoiding foods that consistently trigger headaches may be important in helping to reduce the occurrence of migraine headaches. Eat meals at regular times daily and do not skip meals.

Stress reduction: Integrative therapies that reduce stress, such as yoga, therapeutic touch, and relaxation techniques, are important in reducing migraine attacks.

Regular sleep patterns: It is important for migraine sufferers to get adequate consistent sleep every night. Healthcare professionals generally recommend eight hours of uninterrupted sleep nightly.

Regular exercise: Regular aerobic exercise reduces tension and can help prevent migraines. If a doctor agrees, choosing an aerobic exercise, such as walking, swimming, or cycling, may help decrease migraine attacks. Warm up slowly, however, because sudden, intense exercise can cause headaches.

Caffeine intake reduction: Limiting caffeine consumption to less than two caffeine-containing beverages a day may be of benefit for reduction of migraine attacks.

Light modification: Avoiding bright or flashing lights, and wearing sunglasses, if sunlight is a trigger, may help reduce migraine attacks.

Smoking cessation: Smoking cessation is important in decreasing migraine attacks, as smoke can be a potential allergen that triggers a migraine. Also, nicotine, one of the components of tobacco, stimulates vascular activity in the brain that may trigger a migraine attack.

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