This review examines complementary and alternative therapies for migraine alongside emerging peptide-targeted treatments like CGRP and PACAP antagonists, offering a broader perspective on pain management options.
CGRP + PACAP targetsNovel peptide-targeted therapies — CGRP antagonists (already approved) and PACAP antagonists (in development) — represent the most significant advance in migraine treatment, potentially complemented by alternative therapies
What the researchers found
Complementary and alternative therapies (CAT) show varying levels of evidence for migraine management, while novel peptide-targeting therapies (CGRP antagonists and monoclonal antibodies, PACAP antagonists) represent the most significant pharmacological advance in migraine treatment. The review proposes that CAT may serve as adjunctive therapy alongside these new peptide-based treatments.
Why it matters
Migraine treatment is being transformed by peptide-targeting drugs, but many patients also seek non-pharmacological options due to medication side effects or personal preference. Understanding how complementary therapies work alongside these new peptide-based drugs helps patients and clinicians design comprehensive, personalized treatment plans.
The numbers in context
Women are more susceptible to migraine. Long-term NSAID use is the main first-line approach but leads to side effects and drug adaptation.
How the study worked
Narrative review summarizing the pathophysiology of migraine, the mechanisms and evidence for various complementary and alternative therapies, and the potential of CGRP and PACAP antagonists as novel migraine treatments.
Who was studied
Migraine patients using complementary and alternative therapies
What this study cannot tell us
As a narrative review, it doesn't systematically assess quality of evidence for each therapy. Many complementary therapies have limited high-quality RCT data. The discussion of CGRP/PACAP therapies is not exhaustive. Potential publication bias in alternative medicine studies is not addressed.
How to read the evidence
Preliminary to moderate — individual CGRP-targeting drugs have strong clinical trial evidence, but the evidence for most complementary therapies and PACAP antagonists is still building.
When this study was published
Published in 2024, capturing the current state of both peptide-based and alternative migraine therapies.
The bigger picture
The migraine treatment landscape is shifting from broad pain relievers to targeted peptide-based therapies. CGRP-targeting drugs (erenumab, galcanezumab, fremanezumab) have already transformed prevention, and PACAP antagonists are in development. Integrating these with evidence-based complementary approaches could optimize outcomes for the estimated 1 billion people worldwide affected by migraine.
Questions still open
- Can complementary therapies reduce the dose or frequency of CGRP-targeting drugs needed for adequate migraine control?
- Which specific alternative therapies have the strongest evidence when used alongside anti-CGRP monoclonal antibodies?
Common questions
What are CGRP-targeting migraine drugs?
Can acupuncture or supplements replace migraine medication?
Read the original research
New perspectives on migraine treatment: a review of the mechanisms and effects of complementary and alternative therapies.
Frontiers in neurology, 15, 1372509
Citation
Song, Xiaoli; Zhu, Qian; Su, Lanqian; Shi, Lei; Chi, Hao; Yan, Yalan; Luo, Mei; Xu, Xibin; Liu, Baohong; Liu, Zhengyang; Yang, Jin. (2024). New perspectives on migraine treatment: a review of the mechanisms and effects of complementary and alternative therapies.. Frontiers in neurology, 15, 1372509. https://doi.org/10.3389/fneur.2024.1372509