Novel Approaches to Migraine Treatment

October 3, 2016
Jim Carleton
The last few years has seen a groundswell of promising research and innovative medications and devices designed to prevent or abort a migraine episode. The Association of Migraine Disorders reports on what we believe to be credible research and treatments that will withstand rigorous testing. When AMD refers  to "novel approaches" we do not mean two minute YouTube guided imagery videos, ear piercings, or mentholated showers.  Yes, some people may have benefited from these approaches, but they need to be validated scientifically using rigorous methodology before receiving our endorsement. The Placebo Effect is quite real and needs to be accounted for in those and other simple or "quick-fix" techniques that periodically surface in the popular press or social media. 
 
The following approaches are interesting in general and are a bit of a divergence from the well-deserved focus on CGRP and related topics. They are being studied scientifically, in various settings, and deserve examination.
 
Melatonin
In clinical trials, 3 mg of melatonin daily reduced the occurrence, intensity, and length of headache episodes. Eighty percent of the subjects reported a 50% decrease in headache frequency and 25% saw a complete reduction of headaches.  Female subjects in this study also reported a reduction in menstrual migraines.  Originally cited in Cephalalgia  in 2005, results may have proven difficult to duplicate, but there is new interest. Melatonin, which has recognized  anti-inflammatory effects, may prove a useful alternative to migraineurs who respond poorly to current medications.
 
Ketamine
Ketamine which is often identified as a "club drug", or "Special K", is a dissociative anesthetic once used frequently in both human and veterinary medical practices. Dropped from human medical practice it is still used in veterinary medicine. It is currently being studied in a number of settings for migraine, pain management and depression.  It was recently discussed in several venues at the American Academy of Pain Management 2016 annual meeting. Certainly not for all patients, because of a significant potential for side effects. It is currently being examined, and qualifies as an "unusual" treatment for particularly resistant pain, headaches or PTSD. The current findings on Ketamine have not been peer-reviewed or published and are by no means final.  It currently remains a most unusual treatment possibility that bears further review.
 
Sound Based Therapy
Here is an interesting new treatment based on converting brain activity into audible tones. The tones are then rapidly re-directed back through the brain via small earbuds. Early results suggest a lowering of blood pressure, and a lessening of migraine symptoms. Larger and better designed studies are warranted, however, early indications are promising for this non-invasive technique.
 
Cannabis
A most controversial method of pain management, cannabis is coming under increased scrutiny as strident claims are made regarding its efficacy as an analgesic.  Does it really treat pain? If so, what kinds of pain? It does show promise as the current study cited below indicates. Far more research is needed to establish a cause and effect relationship. There are many competing interests here. Solid science, with a properly designed, unbiased, set of clinical trials could yield much information. Until that time, we just don't know. Anecdotal data is tempting, but we cannot generalize.  Source: https://www.ncbi.nlm.nih.gov/pubmed/26749285
 
None of these treatments claim to be a "cure", as they are in differing stages of study.  More research, in varying degrees, is needed in all of these cases. Could one of these treatments work for you? If pursued properly, we will have more answers over time. Continue to be your own advocate and investigate all treatments carefully. Also, as we have mentioned before, there may be a clinical trial you could qualify for where you would evaluate a treatment early on in the process.