Migraine and Complementary Medicine: Chiropractic, Massage, and Supplements Overview

Complementary medicine encompasses a broad range of non-conventional approaches that are used alongside rather than instead of conventional medical treatment. In migraine, the use of complementary approaches is common — surveys consistently find that a substantial proportion of people with migraine use complementary therapies, often without disclosing this to their conventional healthcare providers. Understanding what complementary therapies have evidence for migraine, what the evidence actually shows, and how to integrate complementary approaches with conventional care provides a framework for making informed decisions.

Chiropractic and Spinal Manipulation

A Cochrane review of manual therapies for migraine found some evidence of benefit for spinal manipulation comparable to established drug treatments, though the quality of evidence was low and the trials had methodological limitations. The evidence is more consistent for cervicogenic headache, where the headache originates from cervical structures that spinal manipulation directly addresses.

Serious adverse events from cervical spinal manipulation, including vertebral artery dissection, are rare but documented. This risk should be discussed with a qualified chiropractor and with a conventional healthcare provider before pursuing cervical manipulation, particularly in people with vascular risk factors.

Massage Therapy

Massage therapy, particularly focused on the suboccipital, cervical, and shoulder muscles, may reduce migraine frequency in some people through its effects on muscle tension, stress reduction, and autonomic nervous system regulation. Small controlled trials have found reductions in migraine frequency with regular massage therapy compared to control conditions.

Herbal Supplements — Feverfew

Feverfew, a flowering plant containing the active compound parthenolide, has been studied in multiple randomized controlled trials with mixed results. The American Academy of Neurology evidence-based guidelines give feverfew a Grade B recommendation, meaning it is probably effective.

Herbal Supplements — Butterbur

Butterbur extract had strong evidence from randomized controlled trials for migraine prevention. However, commercially available butterbur products contain pyrrolizidine alkaloids, which are hepatotoxic, unless specifically processed to remove them. The American Headache Society no longer recommends butterbur due to safety concerns.

Integrating Complementary Approaches With Conventional Care

Disclosing complementary therapy use to conventional healthcare providers is important because some supplements interact with conventional migraine medications. Feverfew may increase bleeding risk when combined with anticoagulants. Herbal products are not regulated with the same rigor as pharmaceutical medications, and product quality varies considerably between manufacturers.