Chapter 3
Alternative Treatments

Since headache medications can cause a number of health risks and side effects, and frequent use of some medications can cause painful rebound headaches, many headache patients turn to alternative treatments in hopes of reducing their usage of traditional headache medicines. Debbie, who turned to alternative treatment, explains: "The doctor gave me a lot of medicine that doped me up and made me feel like I was in a fog. The effect was as bad as the headaches. I threw that stuff out and I switched to an alternative supplement. It gave me more energy, and kept me calmer. After I'd been on it a while I mellowed out, and seemed to get fewer headaches."²⁸

What Is Alternative Treatment?

An alternative treatment is a type of treatment that is not commonly accepted by traditional medical professionals in the United States. Due to limited studies that lack conclusive proof of their safety and effectiveness, most alternative treatments are not approved for use by the Federal Drug Administration (FDA). This is important, because when the FDA approves a treatment, the agency verifies that the advantages of the treatment exceed any possible health risks. And once a treatment is approved, the FDA regulates and sets standards for its use. Alternative treatments, on the other hand, generally are not regulated, and there are no set standards for their use.

In spite of these concerns, a large number of headache patients have found alternative treatments to be safe and effective in treating their headaches. In fact, a 2002 survey involving seventy-three headache patients at the Center for Oral, Facial and Head Pain at New York Presbyterian Hospital in New York City found that 85 percent of the patients surveyed used alternative treatments. Of the patients who reported using alternative treatments, 88 percent said these treatments were beneficial in relieving their headache pain.

Many medical professionals agree, especially when conventional drug treatment is combined with alternative treatments in a method known as complementary treatment. This combination, experts say, can reduce headache pain and lower stress, a key headache trigger. As a result, patients need less medication. Peterson explains: "I certainly do not discount alternative treatments altogether. In fact, while more study needs to be done into a number of them, I am the first to say that a combination of medication, lifestyle changes, and alternative remedies can yield better results for the management of migraine than medication alone."²⁹

Alternative treatments for headaches fall into three categories: behavioral, hands-on, and herbal. Of these, herbal treatments have the longest history.

Herbal Treatment

Herbal treatments use the roots, stems, bark, or leaves of plants that are believed to have medicinal value to treat a wide range of illnesses, including headaches. Such treatments have been used for thousands of years. Indeed, feverfew, which is the most popular herbal treatment for headaches today, was used by the ancient Greeks to treat headaches.

Herbal experts say that feverfew contains natural chemicals that reduce inflammation, platelet clumping, and excess serotonin production, as well as preventing the arteries from going into spasms. Since all of these events are involved in the onset of a headache, if feverfew is taken daily for a few months, it may have the potential to prevent or lessen the frequency of headaches. And when feverfew is used as an abortive treatment, it may lessen the severity of headache pain. In fact, the U.S. Headache Consortium, a group of participants representing, among others, the American Academy of Neurology, the American Headache Society, the National Headache Foundation, and the American Academy of Family Physicians, analyzed data from three clinical studies on the effectiveness of feverfew in treating migraines. Based on the data, the consortium reported that feverfew may very well be an effective form of complementary preventive treatment for migraines and suggested that more research into the herb be undertaken.

Ginger is another popular herb used to treat headaches. Used since A. D. 500 in China and India, ginger is believed to reduce inflammation and platelet clotting as well as generally strengthening the body. In addition, a number of Chinese studies have shown it to inhibit nausea and vomiting. In fact, ginger is used in half of all Chinese herbal medicines as a way to settle the stomach and reduce inflammation. It is also commonly prescribed in India as well as in the West by practitioners of Ayurveda (traditional Indian medicine) for the treatment of headaches. Moreover, because of its antinausea properties, it is especially popular for treating migraines.

Although there are few studies on the effect of ginger on headaches, the Steven Foster Group, devoted to the study of herbs, reports on two studies at Southern Denmark University in Odense on ginger. These studies found that ginger indeed has anticoagulant properties, which means it can reduce platelet clumping and therefore may also provide relief from migraine pain and nausea. In fact, according to the group's website, researchers concluded that "Ginger may exert migraine-headache-relieving and preventive activity without side effects."³⁰

Feverfew and ginger are not the only herbs used to treat headaches. Other herbs such as valerian root and Saint-John's-wort are commonly taken to ease anxiety, stress, and depression. Others, like ginkgo biloba, are used to increase blood flow.

Often a number of herbs are combined. Such is the case of lam kam sang heklin, a Chinese herbal supplement made from a variety of herbs. Produced under strict scientific conditions, lam kam sang heklin has been approved for sale in the United States by the FDA. According to the manufacturer, this product improves blood flow to the brain and inhibits the dilation and constriction of blood vessels that causes headache pain. In fact, the manufacturer claims that the product is 90 percent effective in reducing the frequency and severity of headaches after fifteen to sixty days of use.

Dr. Lam Kam Sang, director of the Lam Kam Sang Medical Research Institute in Hong Kong and developer of the product, describes the effect of the herbal combination on one of his patients:

The pain often attacked at the temple and eye-socket at one side. It hurt so violently that she shed tears and nasal secretion incessantly. She had to take double dosage of anodyne [an opiate pain reliever] and lie down in bed for about an hour for the pain to subside. The pain attacked two to three times a week. Both Chinese and Western medicine failed to make an improvement.… Heklin was prescribed for three times a day. In the first day of taking the medicine, the patient suffered an attack of the pain, but no anodyne was needed. After taking the Heklin for thirty-five days, the symptoms had completely disappeared.… No relapse has ever been found so far.³¹

Hands-on Treatments

Unlike herbal treatments, hands-on treatments involve the manipulation of the body to reduce pain and lower stress. Popular hands-on headache treatments include chiropractic care, massage therapy, reflexology, and acupuncture, with chiropractic care being among the most widely used.

Chiropractic

Chiropractic care is based on the theory that a misalignment of joints in the spine and neck interferes with the blood flow to the spinal cord and through the spinal cord to the brain. Since a reduction in blood flow to the brain occurs before a headache strikes, chiropractors say that by using gentle manipulation, such as rubbing, stroking, pressing, and stretching of muscles, to correct the misalignment of these bones, more oxygen and blood will reach the brain preventing or lessening headache pain. Although few studies exist on the effectiveness of chiropractic care for headaches, many patients find it effective. In particular, patients who suffer from tension headaches in which pain radiates to their necks, report chiropractic manipulation of their necks helps reduce the frequency of headaches and reduces headache pain. Peterson describes the case of one of her patients:

Patty, forty-three, was reluctant to take preventive medications because of the side effects she's experienced with several.… [She] was referred to a chiropractor with special expertise in the treatment of headaches. Patty still has headaches, but now they occur just once or twice a month instead of once a week, and they respond well to a compound analgesic [a mix of aspirin, acetaminophen, and caffeine, for example].³²

Massage and Reflexology

Like chiropractic care, massage therapy involves the gentle rubbing, pressing, and stroking of the body. It is usually administered in a tranquil atmosphere that often includes soothing background music and the use of warm, scented massage oil to reduce friction. Massage has been proven to stimulate the brain to release endorphins, natural chemicals that produce feelings of well-being and diminish feelings of pain. Therefore, it is not surprising that many people report that massage therapy induces pleasurable feelings and relieves stress. Moreover, massage loosens tight muscles in the shoulders and neck, stimulates blood flow, relaxes the body, and relieves feelings of depression.

Massage can be administered to the whole body or to specific parts. A type of massage known as reflexology entails the massaging of the foot and ankle to relieve pain throughout the body. Reflexology is based on an ancient Chinese theory that blockages in an energy channel known as chi, which flows throughout the body, cause pain and illness. In order to clear these blockages, reflexologists massage specific zones in the foot, which they say correspond to all the organs in the body. For example, reflexologists maintain that massaging the toes clears blockages in the head and neck that cause headaches. Although there is little scientific evidence that chi exists, reflexology appears to produce the same effect on the body as a full body massage. Therefore, after undergoing reflexology therapy, patients report feeling calmer and more relaxed as well as experiencing less headache pain. One patient declares: "Reflexology helped my migraines. They were very frequent, but now I can't remember the last time I had one."³³

Acupuncture

Acupuncture is another ancient Chinese treatment that attempts to unblock chi. This is done through the insertion of very fine, sterile needles into specific points throughout the body. The needles are thought to activate the flow of energy through these points, which prevents or reduces pain. Although scientists are unsure why acupuncture relieves pain, many experts theorize that the insertion of acupuncture needles somehow stimulates the brain to release endorphins.

No matter why acupuncture relieves pain, a number of studies have shown that it is indeed an effective pain reliever. A 2002 study at the University of Turin, Italy, compared the effectiveness of treatment with acupuncture for migraines to treatment with flunarizine, a calcium channel blocker. In this study, 160 women with migraines were divided into two groups. One group received acupuncture treatments weekly for two months and then monthly for the next four months. The other group was given a daily dose of flunarizine for the first two months and then for twenty days per month for the next four months. In the first two months, the acupuncture group had significantly fewer headaches. After six months, no differences existed between the two groups. However, although both groups had fewer headaches after six months, only the acupuncture group reported a reduction in pain. In addition, the acupuncture group had fewer side effects.

However, like other alternative treatments, the practice of acupuncture is not regulated by the U.S. government. But since acupuncture has been shown to be so effective in treating headaches, the American Medical Association, the largest physician group in the United States, has approved acupuncture as an acceptable headache treatment. Therefore, it is not surprising that many traditional doctors recommend acupuncture to their headache patients as a complementary treatment, and many patients find it helps them. E., a migraine sufferer, talks about his experience: "I've suffered from migraine headaches for thirty years and have tried all sorts of medications that have been only partially effective. However, with acupuncture I have had effective (sometimes within minutes) relief from migraine pain. I don't fully understand how it works, but for relief of pain I highly recommend it."³⁴

Behavioral Treatments

Unlike herbal and hands-on treatments that treat the body in order to control headaches, behavioral treatments train the mind to reduce feelings of pain and stress. Based on the theory that the mind influences the way the body functions, behavioral treatments include relaxation therapy, hypnosis, and biofeedback.

Relaxation

Just as the name implies, the goal of relaxation therapy is to help people relax and lessen their response to stress. This is achieved through a number of distinct methods that include relaxation tapes, meditation, and visualization, to name a few. Although each method is different, each employs specific mental techniques that relax the body.

Relaxation tapes, for instance, are special audiotapes that contain comforting background sounds, such as soft classical music or tinkling windchimes, to help listeners free their minds of worrisome thoughts. At the same time, voice instructions on the tape lead listeners through a program that teaches them how to relax their bodies. Through a series of exercises that include such activities as clenching and unclenching different muscles, patients learn how to relax their muscles, which lowers the body's response to stress and stress-induced headaches. Often used as a complementary form of treatment, according to many patients, relaxation tapes reduce their stress-induced headaches and thus lessen their need for abortive medicine. Debbie Jo, one patient, explains: "I'm a naturally tense person—your typical nervous Nellie. But when I learned how to relax myself, it helped immeasurably with my headaches. Now when I feel a migraine coming on, I turn to relaxation therapy first. It works for me at least half the time."³⁵

Meditation and Visualization

Meditation and guided imagery are two other popular forms of relaxation therapy. Meditation involves clearing the mind in order to relax the body and relieve stress. To do this, meditators use a concentration technique in which they silently repeat a word or phrase until their mind is cleared and all stressful thoughts are gone. People who meditate report feeling deeply rested and relaxed after as little as twenty minutes of meditation. Indeed, research has shown that during meditation, the production of stress hormones such as cortisol and adrenaline decreases while serotonin levels increase. Moreover, when meditation is practiced often, these changes stabilize so that meditators' bodies react less strongly to stress during their daily life. The result is a lessening in headache frequency and severity.

Similarly, visualization uses the mind and the senses to relax the body. When practicing visualization, people construct a picture in their minds of a peaceful and safe place, such as a favorite vacation spot. They imagine the sights, sounds, and smells of the place. Then they picture themselves in that place, relaxed and pain free. By guiding their minds to this soothing and pain-free place, headache sufferers lower their response to stress and reduce their pain level. "Creative visualization can have a powerful effect on your behavior," explains Paulino. "When you think of yourself as a person without illness, you'll behave like a person free of illness. For example, if you have chronic headaches and see yourself without headaches, you'll likely be motivated to relax, even during stressful times."³⁶

Hypnosis

Like meditation and visualization, hypnosis uses the mind to control the body. During hypnosis, patients are put into a relaxed, trance-like state by a hypnotherapist or through special hypnosis tapes. This state is not unlike that of meditation and visualization. However, unlike visualization where the patient imagines himself or herself relaxed and pain free, during hypnosis, the hypnotherapist uses the power of suggestion to help the patient relax, thereby reducing stress, headache pain, nausea, and vomiting. According to hypnotherapists, this is achieved through the subconscious mind, which controls every function of the body and is more open to suggestion than the conscious mind. Although scientists do not know why suggestions made while under hypnosis can reduce pain, hypnotherapy has become widely accepted as an effective complementary treatment. In fact, the College of Physicians and Surgeons at Columbia University in New York City offers a program on hypnosis to medical students and doctors.

A number of studies have been conducted on the effectiveness of hypnotism and headache pain. A 2002 study at Victoria University of Technology in Melbourne, Australia, for instance, had patients with migraine headaches keep a log for three months in which they recorded the frequency and severity of their headaches as well as the amount of medication they used. The patients continued keeping their daily logs for the next three months, during which time they also listened to headache-reduction hypnosis tapes. Then the data in the patients' logs were compared. Researchers found that during the three months in which the patients were hypnotized, they reported less frequent and less severe headaches. In addition, their medication use was cut in half. Based on this and other studies, many doctors endorse hypnotism as a complementary headache treatment. Headache expert and family physician Larry Deutsch of Ottawa, Canada, explains: "Hypnosis is effective… and provides a powerful complimentary or stand alone therapy to those who suffer from headaches. Stress reduction and relaxation techniques have an important role to play in the treatment in one of the most vexing problems physicians face in practice, the patient with headache."³⁷

Biofeedback

Biofeedback is another method that trains the mind to control the body. Through biofeedback, people learn to regulate involuntary body functions such as muscle tension, blood flow, body temperature, and the workings of the nervous system. During a biofeedback session, headache patients wear special sensors on their head and scalp that electronically monitor their involuntary body functions. These sensors are connected to a computer and a monitor that provide the patient with immediate feedback. For example, when patients are tensing the muscles in their forehead, which causes their blood vessels to constrict, the sensors send signals to the computer. These signals cause the computer to beep or lights to flash across the monitor. When patients see or hear these responses, they know that their muscles are tense. Patients can stop the responses by relaxing their muscles, which they learn to do through instructions from the biofeedback therapist.

Through this monitoring, people learn how their bodies feel when their muscles are tense and when they are relaxed as well as how to respond to tense muscles in order to relax them. Over time, they learn to carry out the same response when they are not connected to the biofeedback machine. This helps keep their blood vessels open. Indeed, biofeedback has been so effective in helping headache patients that the National Headache Foundation recommends it as a nonmedical treatment. Many patients and doctors agree. Medical doctor and headache sufferer Larry Dossey of Santa Fe, New Mexico, describes his experience: "I had classic migraines.… Nothing worked for it—and in desperation I learned how to do biofeedback, a form of relaxation training, which virtually solved the problem."³⁸

Risks and Side Effects of Alternative Treatments

It is true that alternative treatments work for many headache patients. However, like conventional headache treatments, alternative treatments can pose health risks. Herbal treatments in particular can cause problems. Because herbs are natural, many people believe they are unconditionally safe. However, many herbs are as strong as drugs, and like drugs can cause a number of side effects. For example, feverfew can cause stomach pain, mouth ulcers, and swollen lips in some people, while ginseng's side effects include insomnia and diarrhea.

In addition, chemicals in herbs can interact with chemicals in drugs, causing dangerous consequences. According to the results of a study at the University of Utah in Salt Lake City reported at the 2003 annual scientific meeting of the American Headache Society, several popular herbal headache treatments, including ginseng and Saint-John's-wort, may interact with triptans and antidepressant medications in the liver. This can have toxic results when chemicals in the liver turn this combination into a poisonous, and potentially fatal, compound. In fact, it is illegal to sell Saint-John's-wort in France due to herb-drug interactions. In addition, these herbs and valerian root may actually cause or worsen headaches in some people. Even when patients do not mix herbal products and traditional medication, because of lack of set standards and regulations, some herbal products may be stronger than what is reported on their labels. This too can cause a bad reaction. For example, due to their anticoagulant properties, high doses of gingko biloba, ginseng, and Saint-John's-wort can inhibit the blood's ability to clot and cause dangerous bleeding.

Hands-on treatments can also cause problems. Cases of stroke have been reported after chiropractic manipulation of the neck. Although these cases are extremely rare, when the neck is manipulated and the head is rotated, these actions can cause blood vessels in the brain to burst or become stretched and blocked, causing a stroke. Complications from acupuncture treatment, such as the wounding of a nerve or blood vessel with an acupuncture needle, have been reported.

But despite these problems, through the use of alternative treatments, millions of headache patients find relief from headache pain while decreasing their dependence on headache medications. Consequently, many headache patients are willing to take the risk.