A social media study investigates complementary and integrative medicine for migraine

A new study found that more than 90% of patients are using some form of complementary and integrative medicine to manage their migraine. These integrative treatments can include things like nutraceuticals and acupuncture.

A Patient Perspective of Complementary and Integrative Medicine (CIM) for Migraine Treatment: a Social Media Survey” was the first of its kind to use social media, namely the American Migraine Foundation’s Move Against Migraine Facebook group to investigate common complementary and integrative medicine approaches. Dr. Chia-Chun Chiang, assistant professor of neurology and headache specialist at Mayo Clinic in Rochester, MN, and AMF Editorial Board Member, spoke to lead investigator Dr. Deena Kuruvilla, a headache specialist and medical director at the Westport Headache Institute, about the importance of the findings and what it means for patients.

This conversation has been edited for clarity and length.

Dr. Chiang: Dr. Kuruvilla, would you give a quick introduction of CIM?

Dr. Kuruvilla: Complementary and Integrative medicine (CIM) is a practice of incorporating non-mainstream treatments with conventional mainstream treatments. Another term that has been used to describe CIM is Alternative medicine. This term is not as popular because non-mainstream treatments should not be an alternative to mainstream treatments with robust evidence.

Dr. Chiang: Could you share with us what inspired you to start this project specifically investigating the patient perspective on complementary and integrative medicine for migraine treatment?

Dr. Kuruvilla: In my own experience in a headache clinic, I found many patients used integrative medicine approaches to treat migraine. When I would probe them with extra questions, they would say, “Oh yeah, I’m getting my neck manipulated by a chiropractor, I’ve had multiple rounds of acupuncture, I’ve already been taking these vitamins that a naturopathic provider has given to me.” And often patients are only telling me this after I’ve asked those specific questions about natural treatments.

I wanted to find out how prevalent integrative medicine use is among the general population. I wanted a way to do that in a widespread fashion. The American Migraine Foundation and I partnered together with the Complementary and Integrative Medicine Special Interest Section of the American Headache Society to survey patients in the Move Against Migraine Facebook group.

Dr. Chiang: Why is it so important to study this complementary and integrative medicine treatment?

Dr. Kuruvilla: The reason that we have to study integrative medicine is, number one, our patients are going to reach for these options. Patients may perceive them as being natural or safe, where we as clinicians know that some supplements, for example, may not be safe. When I have an open conversation with my patients, they want to know what has evidence and what doesn’t. We owe it to our patients to study these natural methods to see if they’re really helping folks or not.

Download the American Migraine Foundation’s free guide to nutraceuticals for migraine.

Dr. Chiang: What are the key takeaways from the study?

Dr. Kuruvilla: So we surveyed just over 370 patients with migraine. Of those we spoke to, we found 90% of those folks said they’re using integrative medicine. That was pretty remarkable.

Fifty-six percent of patients in the study used a combination of integrative treatments. We asked about three main groups that have some evidence for migraine treatment: supplements, mind-body medicine, and body-based practices. Patients in the study reported using a mix of those different integrative medicine options for their migraine treatment.

When we asked about treatment efficacy, a plurality of patients (34%) said these methods were slightly effective for them.

Dr. Chiang: Can you tell us more about how patients can have a more open, unbiased discussion with their providers? 

Dr. Kuruvilla: I think that patients and clinicians have to meet halfway to discuss these natural approaches. That is because patients could be either helping or harming themselves with some of these natural approaches. As a clinician, I strongly believe providers should learn about all of these natural approaches for headache treatment. In this way, they can guide the patient and potentially warn them against any dangers.

The paper proposes the mnemonic CARE to help providers open up conversations about integrative medicine approaches with patients. We believe that providers should ask about conventional therapy experiences, avoid judgment, review integrative approaches and their limitations, and explore why the patient is interested in pursuing CIM.

Dr. Chiang: Can you speak to patients about why it’s important to participate in this kind of research?

Dr. Kuruvilla: I think it’s really important for patients to be involved in this research and to fill out these surveys if possible because often there are communication deficits between patients and between their clinicians. For example, I don’t think many clinicians may realize how important it is to breach the topic of integrative medicine and review its effectiveness and limitations. A study like this really opens our eyes as clinicians to really ask that extra question about what patients are really doing out there outside of our headache clinic, or our neurology clinic, or our primary care clinic. Consequently, it’s important to hear patient voices and really understand what patients want in their headache care.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.