Migraines

Summary
Acupuncture is a traditional form of treatment that began in China thousands of years ago. Thin needles are inserted into the skin at special points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.

Evidence
There has been quite a lot of research suggesting that acupuncture is likely to help reduce the number and severity of migraine attacks.

Safety
Acupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally).

Cost
A session may cost £40-£60. Frequency of treatment will depend on you and your practitioner.

Find out more
The following professional organisations can help you find a qualified practitioner:
Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society

Summary
The basic principle of homeopathy is that like cures like. Homeopaths use tiny amounts of medicine, which are supposed to jolt the body’s self-healing processes into action. Homeopathy has been called ‘unscientific’ because homeopathic remedies are sometimes diluted (watered down) so many times that no detectable trace of medicine remains. Their response is that they capture a non-material trace of the original material.

Evidence
There have been several research studies but the results are confusing, so we don’t have much evidence to recommend homeopathy as a treatment for migraine. But it is safe, the remedies themselves are relatively inexpensive, and some people are sure that they get relief from homeopathy.

Safety
Homeopathic medicines prescribed by trained professionals are safe. Some patients complain of mild worsening of their symptoms but this generally only lasts a short time. There is potential risk that an enthusiastic pursuit of such a radically different approach can mean that the need for other treatments may be ignored.

Cost
The monthly cost will depend on how regularly you receive treatment. A session with a qualified homeopath varies from £25-£60.

Further information
There are a number of professional organisations covering homeopathy:
The British Homeopathic Association
Faculty of Homeopathy
The Society of Homeopaths

Summary
There are many different types of massage, some more vigorous and going deeper into the muscles than others. Massage has traditionally been used for relaxation. It may be just on one part of the body (for example, the back and shoulders), or it can be done on the whole body. Aromatherapy massage uses pleasant-smelling essential oils.

Evidence
Two small studies have shown that massage reduced the number of migraine attack for three weeks after having massages. It seems likely that massage could play a useful part in self-care for migraine..

Safety
Massage is safe if carried out by qualified massage therapists, and it rarely causes problems. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage.

Cost
Monthly cost will depend on how regularly you receive treatments.

Further information
It is important to find a qualified practitioner such as one registered with The General Council for Soft Tissue Therapies.

Summary
Some people find their migraines are directly triggered by stress, conflicts or emotional distress. Psychological approaches may be useful to help you deal with this.

When people think of ‘talking therapies’ they usually mean either counselling or psychotherapy. Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says “CBT can help you to change how you think (‘cognitive’) and what you do (‘behavioural’). For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.

Evidence
Several small studies have indicated that CBT helped people to manage their headaches better, though this has not been proven in large studies. But CBT may help some people manage stress better and so prevent migraine attacks or cope with them better so that they don’t last so long.

Safety
These techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist.

Cost
In most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£60. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions.

Further information
It is important to find a qualified counsellor or psychologist. Contact The British Psychological Society.

Summary
Osteopathy and chiropractic are hands-on approaches to diagnosis and treatment that focus on the way the muscles and joints work. They are both based on the idea that pain often comes from physical strains and tensions in the body, rather than from inflammation or damage caused by disease. Treatment by an osteopath or a chiropractor often involves spinal manipulation. If tender points in your neck seem to affect your migraine attacks, these approaches might help relieve the pain.

Evidence
There have only been a few research studies. But there is evidence that spinal manipulation may have a short-term effect that is as good as a commonly used preventive drug (amitriptyline).

Safety
Side-effects are rare and mainly linked to manipulation of the neck. Some people experience mild after-effects (aches) from the treatment but they usually last less than 48 hours.

Cost
Once you have learned the movements, you can do the exercises at home, at no cost.

Further information
All properly qualified osteopaths are registered with The General Osteopathic Council

All chiropractors have to be registered with The General Chiropractic Council.

Summary
Yoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation.

Evidence
Two studies suggest that yoga can help prevent migraine. Better studies are needed to be certain. But yoga should help with relaxation and reducing stress, which often causes migraines.

Safety
Yoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.

Cost
You will have to pay for the classes but once you have learned this technique you can practise it at home at no cost.

Further information
Classes are run in most areas by both private tutors and by adult education services. To find a qualified teacher near you see also the The Yoga Alliance
and the The British Wheel of Yoga.