Current Treatment Options in Neurology

, Volume 13, Issue 1, pp 28–40 | Cite as

Nonpharmacologic Treatments for Migraine and Tension-Type Headache: How to Choose and When to Use

  • Robert A. NicholsonEmail author
  • Dawn C. Buse
  • Frank Andrasik
  • Richard B. Lipton

Opinion statement

There are a variety of nonpharmacologic treatments for headache. Educating patients about headache and its management, identifying and managing triggers (via diaries), modifying lifestyles, and understanding the importance of adopting and adhering to interventions (either pharmacologic or nonpharmacologic) are relevant to all persons with headache. In addition, specific nonpharmacologic treatments can be used either alone or in conjunction with ongoing pharmacologic intervention. Strong candidates for nonpharmacologic treatment include individuals with significant headache-related disability, comorbid mood or anxiety disorders, difficulty managing stress or other triggers, medication overuse, and patients who prefer a specific treatment. Behavioral treatments (relaxation, biofeedback, and cognitive-behavioral therapy) possess the most evidence for successful headache management. They have a long history of randomized trials showing efficacy and are considered first-line preventive options. Among complementary and alternative treatments, recent positive findings from randomized trials using acupuncture provide evidence of its potential as a first-line intervention. Other complementary and alternative techniques do not have a consistent base of research to recommend them for headache prevention, but they may be used if the patient prefers this approach or when other first-line interventions (nonpharmacologic or pharmacologic) have not provided adequate results. Among “natural” treatments, both butterbur extract and vitamin B2 have shown efficacy in more than one randomized trial and are thus potentially useful first-line preventive interventions.


Migraine Nonpharmacologic Intervention Headache Disorder Medication Overuse Aspartame 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Conflicts of interest: R. Nicholson: Member of advisory board for Merck, grant from Merck, payment for consultative services with Mercy Health Research; D. Buse: none; F. Andrasik: none; R. Lipton: Member of Advisory Board of Allergan and Merck; payment from Allergan for educational presentations or speaking; grants from GlaxoSmithKline, Allergan, Merck, and Bristol Myers Squibb.

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Robert A. Nicholson
    • 1
    • 4
    Email author
  • Dawn C. Buse
    • 2
  • Frank Andrasik
    • 3
  • Richard B. Lipton
    • 2
  1. 1.Department of Neurology & PsychiatrySaint Louis University School of MedicineSt. LouisUSA
  2. 2.Department of Neurology, Albert Einstein College of MedicineMontefiore Headache CenterBronxUSA
  3. 3.Department of PsychologyUniversity of MemphisMemphisUSA
  4. 4.Ryan Headache CenterMercy Health ResearchSt. LouisUSA

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