Have you ever tried a holistic migraine treatment approach? The Migraine Strong team developed the Treatment Pie to illustrate the need to attack migraine using a multimodal approach. These nine slices represent the medical interventions and holistic migraine treatments that are known to best effect migraine outcomes. When applied together, they have a greater chance of reducing the frequency and severity of migraine attacks than any one slice alone. Each slice is described below.
** While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
The Treatment Pie: A holistic migraine treatment approach
This slice of the pie refers to Acute medications (taken at the onset of an attack) and Preventive medications (taken daily to reduce the number of attacks). Rescue medications can also be prescribed to treat migraine symptoms even if they don’t abort an attack. This also refers to neuromodulation devices (Cefaly, Neurivo, Relivion, gammaCore). Medications are often combined with other holistic migraine treatments to effectively treat migraine symptoms.
Many people with migraine get frustrated and annoyed when they take medications daily without being ‘cured’ of their attacks. The goal of preventive medications is to reduce the number of days you have migraine symptoms by 50%. This target is sometimes an elusive one. Keeping track of your migraine attacks can help you evaluate if the medication is actually working. It is difficult to remember what happens day to day, even without migraine symptoms.
Acute medications should reduce or resolve your symptoms by the 2 hour mark. If your symptoms are not reduced or resolved, or come back, talk to your doctor about adding another or changing to something else.
Many therapies can find their way into this category including chiropractic, massage, craniosacral, acupuncture etc. Each of these will have different effects on migraine for every individual. While some of these treatments didn’t work for me, I have talked to many that found them to be life changing.
As a community, we get so tired of talking about drinking more water. If you fall into the category of already drinking lot of water, you can skip this slice. For information purposes, check out our excellent article by registered dietitian, Danielle Aberman. She does a fantastic job explaining ways to avoid a dehydration headache and talks about how many cups of water we need in a given day to help treat migraine.
Meditation is a holistic migraine treatment and an intentional practice, focusing inward to increase calmness, concentration, and emotional balance. I originally felt like meditation wasn’t for me. I can’t shut off my brain and I often refer to it as a hamster running on a wheel and never stopping. My thought of meditation was never allowing or having a stray thought. Well, that’s not quite right. Meditation is about recognizing the stray thought, releasing any negative thoughts about it and gently coming back to the present moment.
I really like the Calm app and their guided body scans. There are other options such as Insight Timer, Headspace, Unplug, Simple Habit and more. Try a few and see if meditation is helpful for managing your migraine.
You could also try some activities that are meditative like coloring, a “walking meditation” cloud gazing, watching a candle, knitting, etc.
The therapy slice encompasses many different forms of therapy including ACT Therapy, Cognitive Behavioral Therapy (CBT), Talk Therapy, Biofeedback Therapy etc.
Anxiety and depression are commonly associated with migraine. Sometimes finding a therapist that is skilled in coping strategies for chronic illness can help. A therapist can also help deal with everyday stresses and coping with pain and other symptoms of migraine.
Waking and sleeping at the same time each day and avoiding naps is part of having a well ordered sleep schedule. The migraine brain likes routine and having too much or too little sleep can disrupt its happy balance. Our article on sleep and migraine explains it in depth.
A migraine oriented elimination diet, like Heal Your Headache, (limited in scope and time) can be helpful in allowing the brain to calm from its hyper-responsive state. A ketogenic diet, or keto for migraine, can also be helpful and the linked article explains how to get started from the beginning.
Exercise is often recommended for treating and managing migraine. For those of us who have exercise induced migraine attacks, this is often hard to hear. Daily movement IS helpful. But this doesn’t have to be training for a 5K. Beginning with gentle movements, walking around the house or yoga for migraine can be a good place to start. Make sure to not compare yourself to others and what types of workouts they do. We are all individuals and need to start from our own point of health and wellness.
Which combination of slices is most effective in a holistic migraine treatment?
It’s doubtful a day goes by in our Migraine Strong Facebook group without some reference being made to the treatment pie. It is one of our favorite resources, with good reason. In this one graphic we reference every effective piece of treatment we can think of to fight migraine. While each of these slices has a different percentage of effectiveness for every individual, we find that combining them makes the greatest impact in our battle to gain control over migraine.
The theory in practice
When I first started working on this theory, I had been chronic and mostly intractable for 18 years. I had tried many medications to reduce and treat my migraine attacks to no avail and had recently been diagnosed with a migrainous infarction (stroke).
At the end of my rope as far as treatments went, my headache specialist and I combed back through everything. We determined that I hadn’t really tried an elimination diet, but had previously done an avoidance diet. So I reread the Heal Your Headache book by Dr. David Buchholz and put that into action. I committed to the four months of his plan and looked at what else I could do to make this time most effective.
Daily exercise is well known to help with migraine management, so I added it to my list. Several supplements have broad scientific support in their ability to reduce migraine symptoms and attacks so they were added to the mix along with cleaning up my sleep cycle. I kept track of my daily water intake to ensure I was well hydrated. The Calm app was a great way to bring in daily mindfulness and meditation. We also kept my preventive medication the same, but changed my acute/rescue medications.
I wouldn’t say that making all of these changes at one time was easy. It wasn’t. Preparing most of my food at home eliminated some of the easy foods we liked to get on attack days, like pizza and Asian food. And that was a challenge for me! Pausing the treadmill to deal with bouts of nausea was an exercise in sheer stubborn will. And the brain fog I was dealing with, along with copious amounts of pain made everything seem insurmountable.
But I had made a commitment to my family to stick with it for four months. After about six weeks I had an amazing break of 22 days with no head pain! Of course, I thought I was cured. Spoiler alert! I wasn’t.
I had made great strides in figuring out some things that made migraine shrink…and I wasn’t going to give up. The treatment pie was in its infancy and would eventually be pulled together with the help of the wonderful Migraine Strong admin team.
Deciding which holistic migraine treatment to try first
These questions come up quite often. Should I trial one medication or supplement at a time so I know what is working? Should I start diet first to see if that works by itself? What is reasonable in regards to change when it comes to attacking migraine?
These are all good questions and the answer is…it depends. As migraine falls on a spectrum, the mild end and the more severe end, how we attack it will vary. If you have episodic migraine, trialing things within some slices one at a time may work well for you. You could jump on a diet, hydrate, get your sleep cycle organized etc. But when it comes to supplements and medication, we might tell you that trialing one at a time is the right approach to see how things pan out. This way, you would be able to keep a good record of things to see how each addition affected your migraine attacks.
When migraine is more complicated
While it used to be the conventional wisdom to try one thing at a time, throwing everything at migraine (especially when you are chronic) has a greater chance of having a more satisfactory result. At the 2019 Migraine World Summit, Dr. David Dodick agreed that ‘throwing the kitchen sink’ at chronic migraine is how to get the best results.
Once you feel better, you can peel back the layers and see what is working best for you, then eliminate the extraneous therapies. The most important goal is to make a significant impact on your migraine disease and be able to enjoy your life again.
If you are trying a preventive with only limited success, we would recommend discussing with your doctor the option of adding another preventive to the mix to boost the one that you’re currently taking.
Also, dosages for both medications and supplements seem best tolerated when started low and increased slowly, allowing for adjustments to any side effects. The majority of our group has sensitivities to medications and seems to do better with a ‘start low and go slow’ approach. This approach would help with adjustment to the side effects that so many of us find intolerable. This is important for people with migraine and may be even more important for vestibular migraine.
Avoiding analysis paralysis
We want to hit migraine with everything we have to see what sticks. If we can make a dent in the frequency and severity of our migraine attacks, then we can figure out what is helping us the most. Trialing things one at a time could take months or years to figure out what is (or could be) helping us, when it could actually end up being a combination of holistic migraine treatments.
By using this multimodal approach, it also removes the dreaded ‘analysis paralysis’ we can all fall into. This is researching and analyzing every single option, without the ability to make a decision, until we are paralyzed with indecision. Throwing all our options at migraine allows us to figure out what is helping the most! And as always, we will be here to help.
Updated from the originally published article on May 23, 2019.