Non-Pharmacological Treatments of Migraine: Current Evidence and Clinical Practice

Non-pharmacological migraine treatments are commonly used for prevention, may be preferred in sensitive groups such as pregnancy, childhood, and older adults, can be applied as an adjunct to pharmacological treatment, or selected according to the patient condition/preferences. However, most studies are based on heterogeneous designs, resulting in uncertainties regarding level of evidence. This review aimed to summarize the current scientific evidence on the effectiveness of non-pharmacological interventions in migraine, and their role in clinical practice.

Recent studies on acupuncture, physical therapy (PT), psychological therapies (PsyT), biofeedback, and neuromodulation point to modest but clinically significant benefits, although heterogeneity in outcomes and study designs limits the strength of recommendations. Articles were searched PubMed and Web of Science databases through November 2025 including acupuncture, PT, biofeedback, PsyT, and neuromodulation. Evidence levels were provided for headache frequency, intensity, duration, disability, and headache impact, with Grading of Recommendations Assessment, Development, and Evaluation (GRADE), where available. Acupuncture had a small effect on reducing monthly headache days with moderate GRADE. Aerobic exercise, manual therapy (with medical treatment), and yoga regarding PT, individually, ranged from moderate to large effects in reducing on monthly migraine days and a small to large effect size on pain intensity, duration, and disability, but did not have a GRADE. PsyT showed small imroving in monthly migraine, headache days, intensity, disability, medication use, and treatment response, with low GRADE. Evidence for neuromodulation treatments was not reported. Although there is limited evidence for efficacy in sensitive groups, PT and PsyT are approaches that can be considered for these groups due to potential positive treatment effects. These interventions have shown modest benefits in improving migraine symptoms, the overall quality and consistency of the evidence is limited and heterogeneous.