Treatment and management

A significant proportion of migraine patients appears reluctant to take migraine preventive drugs, or do not sufficiently improve when on available medications. The concept of non-pharmacological migraine approaches includes a large diversity of treatments: oral therapies (nutraceuticals or herbal medicines); exercise, behavioural therapies, and multidisciplinary care; acupuncture; peripheral invasive or non-invasive nerve stimulation; and, finally, brain neuromodulation (transcranial magnetic stimulation and transcranial direct current stimulation). The majority of these treatments have few adverse events and their efficacy often seems within the range of usual migraine preventive drugs. However, large placebo-controlled studies are often lacking. Thus, keeping these alternatives in mind when taking care of migraine patients in daily clinical practice is worthwhile.