Thursday, November 1, 2012

CAM for Headache & Migraine Reviewed

CAMDiverse practices of complementary and alternative medicine (CAM) are increasingly becoming mainstream approaches for treating various pain conditions. A team of Australian researchers recently reported the first systematic review examining CAM use specifically for headache and migraine. Overall, CAM use was somewhat prevalent while satisfaction with and effectiveness of these therapies were generally moderate; however, there also were many limitations of the evidence available for analysis.

Writing in an early online edition of the journal Headache, from the American Headache Society, Jon Adams, PhD and colleagues report results of a comprehensive search of the literature from 2000 to 2011 in the CINAHL, MEDLINE, AMED, and Health Sources databases [Adams et al. 2012]. Their search was confined to peer-reviewed research-based articles published in English and reporting findings of CAM use among persons with primary headache or migraine. Individual cases reports were excluded, as were clinical trials of CAM since efficacy analyses for individual therapies were not a part of this review.

Of 565 papers discovered in the search, a total of 12 studies from 8 countries were identified as meeting inclusion criteria for review. A wide diversity of prevalence rates for CAM use in people with headache or migraine was found, ranging from 19% to 82% in select countries. For example, rates were highest in Austria/Germany (82%), moderate in the United States (50%), and lowest in Canada (19%).

CAM users were typically more likely to be female, married, with higher education and annual income levels, and employed full time. Also, persons with more severe headache conditions — in terms of headache days, duration of headache treatment, and frequency of visits to healthcare providers — were more likely to use CAM.

Acupuncture, massage, chiropractic, and homeopathy were the most commonly used CAM therapies in the reviewed studies. One large, nationwide survey suggested that mind-body therapies — eg, meditation, breathing exercises, yoga — also were commonly used in the U.S. Some of the research additionally mentioned exercise, herbal medicine, vitamins/supplements, and therapeutic touch, but at generally lower percentages of users.

There also was evidence of many headache and migraine sufferers using CAM concurrently with conventional medical treatment. From 7% to 30% were using CAM in conjunction with visits to their primary care providers, and from 64% to 93% used these therapies following medical care visits. Overall, CAM was most likely used together with rather than as a replacement for conventional medicine approaches; however, Adams et al. found that users of CAM for headache/migraine commonly did not inform their physicians or nurses about such use.

Motivations for seeking CAM and therapeutic success with these approaches varied significantly across the different studies. In general, it appeared that headache/migraine sufferers were eager to try anything that might help their conditions as long as the approaches were perceived as relatively safe. However, satisfaction levels overall were moderate at best and substantial proportions in some studies did not consider CAM as effective.

The researchers conclude that the significant prevalence of CAM use among persons with headache and migraine represents an important healthcare delivery issue, and practitioners should inquire about and discuss possible CAM use with their patients. Medical professionals also should be alert to possible adverse effects of CAM or interactions between CAM and conventional medical treatments among these patients.

COMMENTARY: There were many limitations of this review and the evidence available for analysis. Although the researchers’ literature search did not include all pertinent databases and was limited to English — which might have left many possibly relevant studies undiscovered — they concede that the dozen studies they analyzed were methodologically weak and inadequate.

In most cases, there was little consistency in results across studies, potentially due to variations in research designs and even the definitions of CAM that were used, Adams et al. observe. Hence, there were wide variations across studies in key factors, such as prevalence and types of CAM used. Only 2 of the 12 studies had sample sizes over 500 patients, with only 1 of them assessing a nationally representative sample.

Reading the report, one can almost sense the researchers’ frustration at trying to consolidate the disparate data in a meaningful fashion. “In short,” they admit, “the role of CAM in treating headache and migraine symptoms or helping patients to cope with their distress in everyday lives remain unclear.”

Adams and colleague further note that the methodological problems discovered in their current review also plague assessments of the clinical efficacy of CAM therapies in treating headache and migraine. They suggest that there is a pressing need for scientifically rigorous studies examining all aspects of CAM, employing sound methodologies and large representative samples of patients.

REFERENCE: Adams J, Barbery G, Lui C-W. (2012), Complementary and Alternative Medicine Use for Headache and Migraine: A Critical Review of the Literature. Headache: J Head Face Pain. 2012(Oct 18); online ahead of print [abstract here].

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