Neurology Q&A: What Neurologists Should Know About Headache Patients and Complimentary Medicine

Anew study shows that specifically among patients with migraine or severe headaches, complimentary and alternative medicine (CAM) use is high and not often reported to care providers. Yet in some cases, use of CAM therapies is suggested by the practitioner. Because CAM use could potentially affect conventional medical therapies, neurologists should be aware of these trends, suggests Rebecca E. Wells MD, MPH of the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, and lead author of the current study.¹

What are the implications of your findings for clinical practice?
The current study involved an analysis of responses to the 2007 National Health Interview Survey, a national cross-sectional survey in which 23,393 American participated. Results showed that adults with migraines/severe headaches used CAM more frequently than those without (49.5 percent vs. 33.9 percent). As with the general neurology population, migraine/headache patients were most likely to use mind/body interventions. Interestingly only 4.5 percent of adults with migraines/severe headaches said that they used CAM specifically to treat headaches. Among the reasons given for using CAM were provider recommendation and patient perceptions that conventional treatments were ineffective or too costly.

More than half of the migraine/headache sufferers who used CAM said that they did not tell their physicians about it. “This was a very interesting finding, and one that has been seen and reported in other studies,” Dr. Wells says. “We think it is important for clinicians to know about their patients' use of CAM therapies since many patients reported using CAM because they felt conventional treatments were ineffective or too expensive, and thus may be non-adherent to conventional interventions.”

Beyond pinpointing patient dissatisfaction or possible non-adherence, knowing about patient CAM use can help the physician better understand the patient as an individual and can improve communication, Dr. Wells suggests. “Providers should be aware of all treatments their patients use, as many use CAM therapies because it is congruous with their values and beliefs about health and life, and addressing patients' underlying goals and beliefs about their health may improve patient-doctor communication and ultimately patient care,” she says.

Given the findings of the research, Dr. Wells suggests that clinicians should directly question patients about CAM use. “Since so many patients with migraines/severe headaches are using CAM therapies without their providers' knowledge,” she asserts, “it is very important for physicians to ask their patients about their use of CAM.”

Are there potential implications for your research in terms of therapeutic research?
“Since we found that CAM use is significantly more common in US adults with migraines/severe headaches than adults without, and mind/body therapies are the most frequently used CAM therapy in adults with migraines/severe headaches, definitive randomized controlled trials are needed to understand the potential therapeutic benefits, mechanisms, side effects, and risks of CAM therapies in adults with migraines/severe headaches,” Dr. Wells asserts.