Hello, everyone, and welcome to my part in migraine management. I will be talking about the non-pharmacological approach in migraine care. My name is Dr. Zainab Al-Awadi, I'm a physiatrist and brain injury specialist at the University of Minnesota, and today we will talk about the following. We will discuss the benefits of non-pharmacological management in migraine, the most common behavioral interventions, lifestyle modifications, dietary supplements, and the role of neuromodulation in non-pharmacological management of migraine. There are many benefits of non-pharmacological management in migraine. We're avoiding or reducing the adverse events of the medications. We're reducing the chances of medication overuse, headache, and side effects. It also helps the population who are very hesitant to use medication management in migraine, quote, unquote, we're not a painful kind of person. It also helps in certain populations where medications are contraindicated, such as in pregnancy or lactation, and it does increase the efficacy of abortive and preventative treatments. Certain behavioral interventions have been proven to help with migraine. Cognitive behavioral therapy, which is a brief and symptom-oriented psychotherapy focusing on managing stress. This has proved by multiple randomized controlled trials on its role on migraine prevention and or treatment. There are certain relaxation techniques, biofeedback, and mindfulness-based stress reduction in helping in migraine management. Lifestyle modifications. Educating your patient on lifestyle modifications is one of the key factors to optimize their migraine management. Regular exercise has been proven to help with migraine management and prevention. Maintaining a sleep hygiene and proper sleep-wake cycle should help with migraine management and prevention. Dietary modification, avoiding certain food would help also in migraine care, as well as proper hydration. Certain dietary supplements has been proven to help with migraine prevention and or management. For example, riboflavin or vitamin B2, it's a flavin mononucleotide that has been proven its effect in energy-related cellular function and mitochondrial function. It also helps with migraine prevention. There are other studies that have proven its role in migraine treatment. The average dose is 200 to 400 milligrams. According to Measles et al., 400 milligrams has been proven to prevent migraine attacks. The role of magnesium as well has been helpful in migraine care, given its inhibitory glutamate expressions through lambda receptors. The average use of magnesium is 400 to 600 milligrams per day. CoQ10 has also been proven to help with migraine care with similar mechanism of action as riboflavin through the mitochondrial cycle. And the general dose has been around 150 milligrams to 300 milligrams per day. Immunomodulation has been the new era in terms of migraine prevention and treatment. The most common one has been used is Cefaly, the third one that you can see in this table. It's very helpful in preventative as well as in acute management. Others that are still in the study cycle or we are still looking into the results, the SPRING-TMS, the GammaCore, and the TDS, all of them have been proven to help with acute and or preventative management of migraine. In conclusion, these interventions have evidence support their effectiveness, there's no one size fits all, and the Comprehensive Migraine Management Plan should combine non-pharmacological and pharmacological approaches to help prevent and treat migraine. Thank you so much.

non-pharmacological migraine management

cognitive behavioral therapy

lifestyle modifications

supplements

neuromodulation devices

lifestyle changes

supplements for migraines