[Non-drug therapies in the treatment of migraine]

The treatment of migraine is complex, and non-pharmacological methods are useful and necessary complements or alternatives to pharmacotherapy. We reviewed techniques that can be recommended for the treatment of episodic and chronic migraine attacks and prevention, and described methods for which there is no evidence of effectiveness. The most important of the therapies that can be recommended for migraine prevention are the elimination of provoking factors, lifestyle modification and regular exercise, and some diets have also been suggested to be beneficial. Based on the available evidence, supplementing preventive treatment with acupuncture or psychological therapy reduces the frequency of headaches in episodic migraine, and some psychological techniques may also be recommended for chronic migraine or attack therapy. Among the nutritional supplements, the effectiveness of riboflavin, magnesium and Q10 have been clinically proven to be effective in the preventive treatment of migraine. Interventional and invasive neuromodulation techniques are not widespread due to specific equipment requirements and increased risk of complications, however, based on good tolerability, some non-invasive methods can be recommended in the treatment of chronic migraine attacks and prevention. A large proportion of patients try other complementary or alternative methods, the efficacy or ineffectiveness of which has not been clinically proven, and therefore cannot be recommended.