If you are getting frustrated because your migraine headaches have not responded to treatment, you are not alone. Half of all people with migraines decide to stop seeking care for their headaches partly because they are dissatisfied with the treatment. But before you go that route and decide to simply live with the pain, consider broadening your options. Research shows that combining treatments from several different medical specialties—called a “multidisciplinary” approach—can be helpful in the treatment of migraine.
The multidisciplinary approach: treating the whole person
The pain of migraine affects far more than your physical body. The stress of coping with pain can cause depression, interfere with your sleep and your ability to do your job, lower your self-esteem and put a strain on your relationships with family and friends. “Migraines can often be pervasive with no ‘quick fix.’ Research shows that in these cases single treatments—such as a pill—are often not effective on their own,” says Robert N. Jamison, Ph.D., Associate Professor in the Departments of Anesthesiology, Perioperative, and Pain Medicine and Psychiatry at Harvard Medical School. “Rather it is important to attack migraines on multiple fronts. A team approach, involving several different disciplines, can be a good solution for many people.” Such a team might include a neurologist, as well as specialists in pain, mental or behavioral health, biofeedback, physical therapy, and rehabilitation medicine.
A multidisciplinary approach has another benefit: It helps give you the resources and coping skills to manage the disabling effects of the pain that affects every aspect of your life. But you don’t have to coordinate these specialties yourself, reassures Dr. Jamison. “There are headache or pain centers that develop migraine management plans for each patient and offer care from many disciplines under one roof. Or, if you can’t find one of these, your primary care doctor can help you assemble the treatments that are right for you.”
Multidisciplinary strategies for migraine management
If you don’t have access to a multidisciplinary headache center, you should begin by talking to your primary care doctor, says Dr. Jamison. “As a first step, you can track your headaches in order to find out what your migraine ‘triggers’ are. This will help to direct you to the specialists you need.” As an example, Dr. Jamison points out that stress may be both a cause and an effect of migraine. Not only can it trigger a headache, but it can also result from having to cope with the pain and disruption of routine. So finding specialists to help you reduce and manage your stress might have a dual benefit: fewer and less severe headaches, as well as reducing the life stress of having a chronic pain condition.
You can learn stress reduction techniques from biofeedback and relaxation training, as well as through ‘talk therapy’ with a mental health counselor. Regular exercise, either on your own or with the help of a physical therapist, is also a stress reducer. “I recommend combining medical interventions—such as medication—with changes in lifestyle and behavior, including exercise, a healthy diet and stress reduction,” says Dr. Jamison. Another part of the multidisciplinary “package,” according to Dr. Jamison, might include such complementary/alternative therapies such as acupuncture, massage, craniosacral therapy, or herbal medicine. While the evidence for the effectiveness of these treatments is not definitive, they have helped some patients, says Dr. Jamison. It is very important, he stresses, to coordinate all herbal and alternative treatments with your doctor, to make sure that they are safe for you.
Other articles on this website describe such treatments as biofeedback, relaxation training, and acupuncture/acupressure for the treatment of migraine. Below is a description of some other possible therapies to consider, always in consultation with your doctor:
Herbs and botanicals not only treat acute pain, but may also relax and balance the body. They may be taken orally, inhaled used in warm baths or massage, or compresses. Be sure to discuss any herbal treatments with your health care professional, since there may be dangerous interactions with prescription drugs.
Craniosacral therapy is an extremely gentle technique that is said to release obstructions in the flow of craniosacral fluid (which bathes the brain and spinal cord), as well as ease pressure on the bran through minute movements of the bones in the skull. There is no conclusive evidence that this helps migraine, although some patients report benefit.
Yoga and Tai Chi are mind-body practices that strengthen and stretch the body while calming the mind and emotions. Other benefits include increased blood flow, release of endorphins (“feel good” hormones), removal of toxins and regulation of serotonin, a brain chemical.
Whatever combination of techniques you choose, says Dr. Jamison, “Recognize that some of the things you do to take control of your pain—including rest, diet, lifestyle, stress management, exercise, and your own attitudes—can be as important as what is
done to you.”
Dysvik, E., Natvig, G., Eikeland, O., & Brattberg, G. (2005). Results of multi-disciplinary pain management program: 6 and 12 month follow-up study. Rehabilitation Nursing. 30:5.
Lemstra, M., Stewart, B., & Olszynski, W.P.(2002). Effectiveness of multidisciplinary intervention in the treatment of migraine: a randomized clinical trial. Headache 42:845-854, 2002. P. 845
Young, W. & Silberstein, S. (2004) Alternative therapies for migraine.In Migraine and Other Headaches, New York, NY: AAN Press.