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SCOTTSDALE, Ariz. -- Acupuncture, massage, yoga, biofeedback, meditation, and other complementary practices can have a positive effect on migraine and tension headaches, a researcher said here.

Evidence about for headache management -- including those promoting stress reduction and relaxation -- is growing, noted Rebecca Wells, MD, MPH, of Wake Forest Baptist Health in Winston-Salem, North Carolina, at the

About practices to help manage pain, but most of those patients did not discuss it with their healthcare providers, according to Wells. "People with migraines and severe headaches used these complementary treatments more frequently than people who didn't have migraine -- most commonly, mind-body therapies such as deep breathing exercises, meditation, and yoga," she said.

Complementary health approaches usually fall into one of six categories for headache patients, she noted:

• Lifestyle and behavioral treatment, which range from "healthy diets, regularly scheduled meals, staying well-hydrated, and going to bed and getting up at the same time every day," said Wells, to biofeedback and cognitive therapy
• Mind-body interventions such as meditation, yoga, and tai chi
• Herbs and supplements such as butterbur, feverfew, riboflavin (vitamin B2), and magnesium
• Acupuncture
• Massage
• Chiropractic manipulation

While for non-pharmacologic headache treatment are being developed by the American Academy of Neurology and the American Headache Society, a recent showed that several complementary practices can reduce headache frequency and symptoms, Wells noted.

"Acupuncture is a really great modality because it has a lot of good evidence," she said. "If people aren't interested in medications -- or would consider using it on top of what they are already doing -- acupuncture can help."

Two significant risks from complementary treatments are possible toxicity from supplements such as (Petasites hybridus root) and the potential risk of from chiropractic manipulation, she observed. Unprocessed butterbur contains pyrrolizidine alkaloids (PAs) which can cause liver damage; only butterbur products that have been and labeled or certified as PA-free should be used, according to the NIH's National Center for Complementary and Integrative Health.

As a clinician, Wells considers complementary options for all headache patients. "Sometimes, there is modality a patient already has expressed interest in," she said. "Interest is the number one priority -- is this something they want?"

Equally important is assessing what other comorbidities or problems might be making a patient's headaches worse. "If patient describes a lot of stress and anxiety, mind-body practices may help," she explained. "If they have a lot of constipation, magnesium might be a good option."

And almost all patients can use counseling about lifestyle: "I explain it in the context of 'the migraine brain doesn't like a lot of change' -- that you need regularly scheduled meals, sleep, and exercise," she said.

A big barrier to complementary approaches is time; many complementary practices require energy and effort. "For some people, it's just easier to take a pill. Some treatments require a change in lifestyle or a change in the way people manage their time," Wells noted.

"But one of the beautiful things about complementary treatments is that benefits may persist," she said. "Patients may change the way they relate to the world and that can have a significant effect."