NHF Headlines, Winter, 2011
Complementary and Alternative Therapies
By Alexander Mauskop, MD, FAAN,
Director of the New York Headache Center, New York NY
(You may also want to read this article on headaches in children elsewhere on our site)
Parents of kids with headaches frequently ask about complementary and alternative approaches, hoping to avoid prescription medications and their associated side effects. As it turns out scientific studies have shown that many of these alternative treatments can be beneficial in reducing headaches, with very few side effects. Taking these factors into account, the treatments described below are worth trying by most, if not all, headache sufferers. However, before considering any kind of medication, whether conventional or alternative the first
step is to make sure that the child has healthy habits. Parents and children, especially adolescents, should be counseled about the importance of regular and nutritious meals without any caffeine, chocolate or other known dietary migraine triggers. Frequent exercise and regular s1eeping patterns are also important factors in decreasing headaches.
Stress is a major contributor to headaches, even in young children. One of the best treatments for migraine and tension-type headaches is biofeedback. Many studies have shown that biofeedback works well, with long-lasting benefits. However similar and less expensive techniques such as self-taught progressive relaxation and meditation, work equally well. The advantage of biofeedback is that a biofeedback therapist can make the learning process easier and can act as a coach and motivator.
Supplements for Headache Prevention
Magnesium deficiency is a common contributor and, in some cases, the main cause of migraine and cluster headaches. Daily magnesium supplementation can be effective in preventing headaches although oral supplementation does not help a small minority of magnesium-deficient patients who have poor absorption. These latter patients usually respond well to an intravenous infusion of magnesium. The recommended daily dose of magnesium is 400 mg. for adults and children weighing more than 90 lbs. Magnesium should always be taken
with foo4 otherwise it can cause diarrhea and stomach pains. If one type of magnesium causes these side effects even when taken with food, another type should be tried.
Co-enzyme Ql0 (CoQl0) is an ingredient present in each cell of our bodies and was found to be deficient in one third of children with migraines. Taking 300 mg of CoQl0 daily can prevent migraine headaches in adolescents who are deficient. A proportionally smaller dose is given to younger children.
Feverfew is an herb that has been in use for the treatment of headaches for 100 years. It is very safe except in those suffering from pollen and other allergies because they could also be allergic to feverfew. The dose of feverfew varies depending on the manufacturer.
Butterbur, unlike feverfew, is an herb that has to be purified to be safe for consumption. Butterbur products made by the German company Weber & Weber and sold under several brand names are considered safe. The usual dose for adolescents is 150 mg daily.
Acupuncture was studied in dozens of clinical trials and proven to relieve migraine and tension-type headaches. While patients frequently express concern about discomfort from acupuncture needles, treatment is usually not painful. Some people experience an immediate effect, but more often, weekly sessions are needed before beneficial effects are seen. A typical course is at least 10 weekly sessions.
Botox does not belong to the group of alternative therapies, but nevertheless it is a safer treatment than drugs. Botox injections were just approved by the FDA for the treatment of chronic migraines in adults. Chronic migraine, which is defined as headaches occurring on l5 or more days each month, affects more than 3 million Americans. In the past 15 years of using Botox, I have treated many children with chronic headaches aged l0 and older with excellent results. The
main drawback of Botox is its cost, but, with the recent FDA approval, more insurance companies will be compelled to cover it.
Since this article was published we have discovered that the butterbur product made in Germany is no longer allowed to be sold there because the company changed its purification process and did not repeat all of the required safety studies. Butterbur made in Germany and in the US is still sold in the US, but our FDA does not regulate herbal products and does not require the extensive safety tests that are required in Germany. We no longer recommend butterbur for our patients, children or adults.