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Treatment for migraine with aura12/24/2023 ![]() The most commonly used nutraceuticals which have shown some evidence in migraine prevention are riboflavin (vitamin B2), coenzyme Q10 (CoQ10), magnesium, butterbur root extract ( Petasites hybridus), and feverfew ( Tanacetum parthenium). ![]() In patients with migraine, the use of this kind of non-pharmacological therapy is growing and is likely to be widely underestimated. They have a particular appeal to patients with chronic diseases who hope to avoid the issues associated with long-term prescription treatments. Their use is becoming increasingly popular in the general population. Nutraceuticals are defined as food or dietary supplements that provide medicinal or health benefits. We will also briefly review the invasive strategies-represented by stimulation of the occipital nerve, the sphenopalatine ganglion, or the cervical spinal cord-which can be considered in chronic migraine patients who have repeatedly failed previous approaches. These may potentially offer an alternative for episodic migraine patients who hope to avoid the side effects of pharmacological therapies. With respect to the latter, we will analyze in detail the available non-invasive techniques (the most significant of which are summarized in Table 1). Finally, we will focus on the relatively novel area of neuromodulation. The treatments that are analyzed in this article range from commonly used and easily accessible nutraceuticals, like magnesium and riboflavin, to well-established psychological therapies such as cognitive-behavioral therapy (CBT). We will particularly concentrate on new strategies backed by robust evidence, prioritizing the attention of the reader on randomized controlled trials (RCTs), when these are available. This review will focus on acute and preventive non-pharmacological approaches to migraine therapy. However, recent years have seen a proliferation in new therapeutic strategies for tackling migraine, as well as novel techniques that offer promising areas of development. Unpleasant side effects and lower than hoped for efficacy can lead to low treatment compliance and other complications, such as headache chronification and acute medication overuse. The currently available oral pharmacological migraine treatments may be poorly tolerated by some patients. Its high prevalence and frequency in young people at the peak of their productive years causes it to rank as the sixth cause of disability in the world. Migraine is one of the most common neurological diseases with a possible cumulative lifetime incidence of up to 50% in women and 20% in men. This review discusses the most recent and evidence-based advances in non-pharmacological therapeutic approaches for migraine, offering alternatives to drug treatment for both the commonly encountered episodic cases as well as the more complex migraine phenotypes, which are capable of challenging even the headache specialist. In recent years, promising strategies for migraine therapy have emerged alongside a progressively better understanding of the complex pathophysiology underlying this disease. ![]() These patients may benefit from invasive treatment strategies. At the opposite end of the spectrum, clinicians might be faced with patients who have proven refractory to numerous medications. ![]() Occasionally, this need might arise in the context of low-frequency migraneurs who are not keen to use medication or fear the potential side effects. There is a strong need in clinical practice for alternative approaches for both acute and preventive treatment. However, the efficacy of pharmacological therapies may have unsatisfactory efficacy and can be poorly tolerated. Migraine is one of the most common and debilitating neurological disorders. ![]()
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