Integrative migraine management within a healthcare system Part 1: Overview and conventional approaches

Migraine is a complex neurological disorder that affects over 1 billion individuals worldwide. While a growing number of migraine therapies have recently become available, migraine remains the leading cause of disability among adults under the age of 50. The unmet burden of migraine is likely due to several elements. These include lifestyle factors such as stress, sleep, diet, and activity that, when compromised, can contribute to heightened migraine disability. Additionally, comorbidities involving the gastrointestinal, cardiovascular, and immunological systems can often worsen migraine disability. An integrative medicine approach has potential to synergistically address these elements while providing whole person migraine care. This model is especially imperative for pregnant, nursing, pediatric, or medication overuse migraine populations for whom non-pharmacologic and behavioral options are often the cornerstone of treatment. In this article, we review the Scripps model for providing multi-specialty integrative care for addressing migraine within a healthcare system. Part 1 of this article will provide an overview of migraine and updates on pharmacological and procedural care. Part 2 will review behavioral, complementary and neuromodulation care options.