Medical hypnosis for migraine management: A systematic review.

Introduction and Purpose Migraine is a widespread neurological disorder characterized by severe, pulsating headaches often accompanied by nausea, vomiting, and hypersensitivity to light and sound. Although its exact cause is still under investigation, recent studies suggest that vitamin D deficiency may play a role in migraine occurrence and severity. Vitamin D, known primarily for its role in bone health, also affects the nervous and immune systems, and may influence inflammatory processes involved in migraine pathogenesis. This literature review aims to explore the relationship between vitamin D supplementation and the frequency and intensity of migraines, and whether supplementation could support migraine treatment. Material and Methods A comprehensive literature review was conducted using the PubMed database, focusing on articles published until the end of 2023. The search included the keywords: "vitamin D," "migraine," "headache," and "supplementation" in various combinations. Relevant studies were selected based on criteria such as monitoring vitamin D levels and the use of supplementation as an intervention in migraine patients. Results The results of the review suggest that vitamin D deficiency may be associated with an increased frequency of migraines. Supplementation with vitamin D was linked to a reduction in both the frequency and severity of migraines. While not all studies were consistent, the majority indicated that supplementation had a positive impact, particularly in individuals with vitamin D deficiency. Conclusions The findings suggest that vitamin D deficiency could be a risk factor for migraines, and that supplementation with vitamin D may help reduce the severity and frequency of migraine attacks. Although further research is required to establish optimal dosages and treatment protocols, vitamin D supplementation shows promise as a supportive therapy in migraine management.

ObjectivesThe aim of this Delphi survey was to establish an international consensus on the most useful outcome measures for research on the effectiveness of non-pharmacological interventions for migraine. This is...

The gut–brain axis has emerged as a potential therapeutic target in migraine management. Several randomized controlled trials (RCTs) have evaluated probiotic supplementation in migraine, yet their findings remain heterogeneous. The aim of this study was to systematically assess and quantitatively synthesize the effects of probiotics on migraine-related outcomes. A systematic review and meta-analysis of randomized controlled trials was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD420261327461). Electronic databases were searched from inception to January 2026. Random-effects meta-analyses were performed to calculate pooled standardized mean differences (SMD) with 95% confidence intervals (CI). Primary outcomes included migraine attack frequency, migraine duration, and migraine severity. Secondary outcomes comprised inflammatory biomarkers, including high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-alpha (TNF-α). Risk of bias was assessed using the Cochrane Risk of Bias 2 (ROB 2) tool. Six RCTs involving 422 participants were included. Overall, probiotic supplementation significantly improved migraine-related outcomes compared with placebo (p<0.00001). Subgroup analyses demonstrated significant reductions in migraine attack frequency (p=0.002), migraine duration (p=0.0003), migraine severity (p=0.0006), and migraine disability assessment (MIDAS) score (p= 0.04). Substantial heterogeneity was observed across studies (I²=91%). Regarding inflammatory biomarkers, probiotic supplementation was not associated with significant reductions in hs-CRP (p=0.24) or TNF-α (p=0.66). The pooled analysis of inflammatory markers also showed no significant overall effect (p=0.28). Most trials were judged as having a low risk of bias or some concerns. In conclusion, probiotic supplementation is associated with significant improvements in migraine frequency, duration, severity, and disability, supporting its potential as an adjunctive therapeutic strategy in migraine management. The absence of significant effects on inflammatory biomarkers suggests that these clinical benefits may be mediated through alternative pathways within the gut–brain axis rather than systemic inflammation.

Background and Objectives: Migraine is a common neurological condition that significantly impacts quality of life, especially in women during their reproductive years. Pregnancy poses unique challenges for migraine management due to hormonal changes and the limited use of pharmacological treatments. Non-pharmacological interventions, such as physiotherapy, exercise, and relaxation techniques, offer promising alternatives for managing migraines during this critical period. This study aims to evaluate the effectiveness of physiotherapy, structured exercise, and relaxation techniques in reducing migraine frequency, severity, and duration while improving psychosocial outcomes such as quality of life, stress levels, and sleep quality in pregnant women. Materials and Methods: Sixty pregnant women diagnosed with acute migraine were randomly assigned into three intervention groups: physiotherapy, structured exercise, and relaxation techniques. Each intervention lasted 8 weeks. The primary outcomes included migraine frequency, severity (measured by VAS), and duration. The secondary outcomes included quality of life (SF-36), stress (PSS), and sleep quality (PSQI). Statistical analyses were conducted using one-way ANOVA and paired t-tests. Results: All interventions significantly reduced migraine frequency, severity, and duration (p < 0.05). Physiotherapy demonstrated the greatest reduction in migraine frequency (45%) and severity (36%), while exercise yielded the most significant improvement in duration (42%). Relaxation techniques were particularly effective in reducing stress and anxiety levels. Quality of life and sleep quality improved across all groups, with unique benefits observed for each intervention. Conclusions: Physiotherapy, structured exercise, and relaxation techniques are effective, safe, and non-invasive interventions for managing acute migraines during pregnancy. These findings provide evidence-based alternatives to pharmacological treatments, highlighting the importance of holistic approaches to migraine management during pregnancy. Further research is needed to confirm long-term efficacy and explore combined interventions.

Background: The literature on the long-term use of muscle relaxant medications for chronic pain reveals a nuanced landscape characterized by varying degrees of efficacy, safety concerns, and the potential for combination therapies. The introduction establishes the complexity of chronic pain management, emphasizing the need for a multifaceted approach that includes both pharmacological and non-pharmacological interventions. Literature Review: The systematic reviews by (Orrillo et al., 2022) and (M. Weisman et al., 2024) provide a critical lens on the efficacy and tolerability of muscle relaxants, revealing a lack of substantial evidence supporting their long-term use in chronic pain management. The findings emphasize the need for cautious application of these medications, particularly given the potential for adverse effects and the ambiguities surrounding their effectiveness over extended periods. Lastly, the exploration of muscle relaxants' role in post-chemotherapy and radiotherapy contexts, as discussed by (Radkowski et al., 2024), broadens the scope of their application, indicating that muscle relaxants may serve a critical function beyond traditional pain management. This perspective encourages further inquiry into their long-term efficacy and safety in various clinical settings. Conclusion: In conclusion, the literature presents a complex picture of muscle relaxants in chronic pain management. While they may provide short-term relief, their long-term use raises significant safety and efficacy concerns. The integration of combination therapies and non-pharmacological interventions appears crucial for optimizing treatment strategies. Future research is necessary to clarify the long-term implications of muscle relaxant use and to establish more definitive guidelines for their application in chronic pain management.

Emerging evidence suggests that air pollution, particularly fine particulate matter (PM2.5), may exacerbate migraine. Northern Thailand experiences severe seasonal air pollution, offering a unique context to investigate this association. This study aimed to evaluate the impact of seasonal PM2.5 exposure on migraine frequency, severity, emergency room (ER) visits, and medication use. This retrospective observational study included 42 adult migraine patients attending a university hospital's headache clinic from 2021 to 2023 who completed monthly headache diaries. PM2.5 data were obtained from national monitoring networks. "Polluted months" (January-May) were compared with "non-polluted months" (June-December). Study outcomes included headache frequency (days/month), pain severity (mild/moderate/severe), ER visits, and medication use. Among 42 patients (mean age: 39.2 years; 57.1% female), headache frequency was higher during polluted months (6.4 vs 4.3 days/month, P < 0.001). All pain severity levels increased significantly during polluted periods. ER visits rose markedly (3.37 vs 0.65 visits/patient, P < 0.001). Use of both migraine-specific and non-specific medications per patient was significantly greater in polluted months. PM2.5 exposure is associated with increased migraine burden. Seasonal air pollution may worsen headache frequency, severity, and healthcare utilization. Air quality should be considered in migraine management and environmental policy planning.

BackgroundChronic pain management in older adults can be challenging for primary care clinicians due to comorbidities, side effects, and complicated guideline recommendations. Clinical decision support systems (CDSSs) may improve care by integrating guideline-based recommendations, synthesizing relevant patient data, and facilitating shared decision-making. I-COPE (Improving Chicago Older Adult Opioid and Pain Management through Patient-centered Clinical Decision Support and Project ECHO) is an electronic health record–based CDSS designed to gather patient-reported data and support primary care clinicians in managing chronic pain, opioid use, and opioid use disorder in older adults.ObjectiveThis study examined clinicians’ views on challenges in managing chronic pain and their opinions on I-COPE.MethodsWe conducted semi-structured interviews with 18 clinicians (16 physicians and 2 advanced practice nurses) from 2 University of Chicago Medicine primary care clinics (internal medicine and geriatrics) piloting the I-COPE CDSSs in 2021. The interview guide was informed by the Consolidated Framework for Implementation Research and explored current practices in chronic pain management, challenges, and feedback on I-COPE tools.ResultsOf the 18 participants, 12 (67%) identified as female, 13 (72%) as White, and 9 (50%) had practiced for 10 years or less. Participants stressed the importance of a comprehensive, patient-centered approach to chronic pain management and prioritized multimodal and nonpharmacological treatments. Major barriers to effective chronic pain management were comorbidities, limited visit time, insurance coverage restrictions, and opioid misuse concerns. Most clinicians found the CDSSs beneficial for standardizing multimodal care discussions, enhancing visit efficiency, eliciting patient goals, and facilitating shared decision-making conversations. Clinicians raised concerns about the complexity of the intervention, anticipated issues with clinic workflow, and desired more adaptability. The primary care clinicians in this study demonstrated strong alignment with current pain management guidelines, prioritizing patient-centered pain management using multimodal treatments. They identified I-COPE as a promising tool to reinforce evidence-based practices, increase efficiency, and strengthen patient-clinician communication. However, implementation challenges—particularly around accessibility for older adults, workflow integration, and tool complexity—highlight the need for further refinement and support.ConclusionsI-COPE offers a promising approach to support primary care clinicians in providing patient-centered guideline-based chronic pain and opioid management for older adults. Further efforts to improve usability and adaptability for real-world workflows and equitable access for older adults should be prioritized.

To correlate the reduction in migraine frequency with change in phosphene threshold of transcranial magnetic stimulation during levetiracetam treatment. Several case series have suggested levetiracetam efficacy may be effective in the management of migraine. Phosphene threshold is reduced in patients with migraine with aura, migraine without aura, and menstrual migraine. Preventive treatment may raise phosphene threshold while reducing headache frequency. Subjects experiencing 4-10 migraine attacks per month and not currently receiving preventive treatment for the indication of migraine were recruited into an open-label trial using levetiracetam, and asked to record headache symptoms, severity, duration, and acute medication use in a daily diary. Following a 28-day qualifying baseline period, subjects were titrated over 6 weeks to either a total daily dose of 3000 mg or their maximum tolerated dose (minimum tolerated daily dose of 1000 mg required). Transcranial magnetic stimulation was performed at day 28 and days 26, 28, 84, and 154. The visual cortex of each subject was stimulated 2 times at 20% power. Power was increased by 10% increments until at least one of the 2 stimulations produced a positive phosphene response. Once a positive response was achieved, a random order of 5 stimulation intensities surrounding the initial positive threshold was generated and given 3 times per session. Stimulation intensities were -10%, -5%, 0%, +5%, and +10% in relation to the positive threshold achieved. To eliminate a learning curve distortion, only observations at days 28, 84, and 154 were used for analysis. The mean phosphene threshold was defined as the average of the lowest positive threshold of the 3 stimulation sequences per visit. Ordinary least squares regression was used to evaluate the association between the change in mean daily headache rate from visit 3 to visit 7 and the change in mean transcranial magnetic stimulation threshold during the same period. Sixty-one subjects were enrolled. Twenty-one subjects were discontinued (because of poor study compliance or attack frequency) during the baseline phase prior to study drug initiation, and an additional subject whose data were not analyzed because of suspect quality. During the first 6 weeks on study drug (titration phase), 8 subjects dropped out (20.5%). Full analysis of the remaining 31 subjects, who reached a maintenance dose after 6 weeks on study medication, was performed. Subjects were largely white, female, and had a mean age of 41 +/- 13 years. Increasing age (beta = 1.27, P = .09), nonwhite race (beta = 6.90, P = .03), and diagnosis of tension-type headache (beta = 6.12, P = .095) were found to be associated with a higher mean transcranial magnetic stimulation threshold. Conversely, increasing body mass index was found to be associated with a lower mean transcranial magnetic stimulation threshold (beta = -1.19, P = .005). The number of migraine attacks decreased from 4.24 during the baseline interval to 2.53 during the interval preceding visit 7 (P = .001). There was a small but significant increase in transcranial magnetic stimulation threshold from visit 3 to visit 5 (P = .03) and visit 3 to visit 7 (P = .03 omnibus test). However,the difference between visit 5 and visit 7 was not statistically significant (P = .88). The mean transcranial magnetic stimulation threshold did not change from visit 5 to visit 7. Phosphene threshold increased during treatment with levetiracetam. At the 10% significance level, headache frequency and phosphene threshold were negatively correlated.

We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.

Migraine is a common and potentially disabling disorder for patients, with wide-reaching implications for health care services, society, and the economy. Nausea and vomiting during migraine attacks are common symptoms that affect at least 60% of patients suffering from migraines. These symptoms are often more disabling than the headache itself, causing a great burden on the patient’s life. Nausea and vomiting may delay the use of oral abortive medication or interfere with oral drug absorption. Therefore, they can hinder significantly the management and treatment of migraine (which is usually given orally). The main treatment of pain-associated symptoms of migraine (such as nausea and vomiting) is to stop the migraine attack itself as soon as possible, with the effective drugs at the effective doses, seeking if necessary alternative routes of administration. In some cases, intravenous antiemetic drugs are able to relieve a migraine attack and associated symptoms like nausea and vomiting. We performed an exhaustive PubMed search of the English literature to find studies about management of migraine and its associated symptoms. Search terms were migraine, nausea, and vomiting. We did not limit our search to a specific time period. We focused on clinical efficacy and tolerance of the various drugs and procedures based on data from human studies. We included the best available studies for each discussed drug or procedure. These ranged from randomized controlled trials for some treatments to small case series for others. Recently updated books and manuals on neurology and headache were also consulted. We herein review the efficacy of the different approaches in order to manage nausea and vomiting for migraine patents.

Background Butorphanol is marketed as a treatment for migraines; however, evidence suggests that the harms of its use exceed the benefits. The short half-life of butorphanol places patients at high risk for opioid dependence and makes tapering a challenge. Buprenorphine/naloxone has unique pharmacological properties that are beneficial in chronic pain treatment. At this time there is limited published data on the use of micro-dosing initiation regimens in patients with chronic pain, especially in older adult patients. Aims This article presents the case of an older adult patient for whom a buprenorphine/naloxone micro-dosing regimen was successfully utilized to aid discontinuation of butorphanol nasal spray, assist with opioid tapering, and manage chronic pain. Methods This case took place in an outpatient setting while the patient was receiving care from an interprofessional chronic pain service. The electronic medical record was reviewed to obtain a summary of the case data. Informed patient consent was obtained. Results We present a case of an older adult patient who had been using butorphanol nasal spray for migraine and general pain management for over 20 years. The risks of ongoing use of butorphanol (i.e., inter-dose-related pain, opioid dependence, possible opioid-induced hyperalgesia, and fall risk) no longer exceeded any perceived benefit. The patient was successfully transitioned onto sublingual buprenorphine/naloxone using a micro-dosing regimen. Conclusions This case provides an example of the potential benefit buprenorphine/naloxone can have for patients with chronic pain and previous opioid exposure, especially older adults at risk of central adverse effects of opioids.

To determine the proportion of patients who have a diagnosis of migraine in a sample of Australian general practice patients, and to review the prophylactic and acute drug treatments used by these patients. A cohort of general practitioners collected data from about 30 consecutive patients each as part of the BEACH (Bettering the Evaluation and Care of Health) program; this is a continuous national study of general practice activity in Australia. The migraine substudy was conducted in June-July 2005 and December 2005-January 2006. Proportion of patients with a current diagnosis of migraine; frequency of migraine attacks; current and previous drug treatments; and appropriateness of treatment assessed using published guidelines. 191 GPs reported that 649 of 5663 patients (11.5%) had been diagnosed with migraine. Prevalence was 14.9% in females and 6.1% in males. Migraine frequency in these patients was one or fewer attacks per month in 77.1% (476/617), two per month in 10.5% (65/617), and three or more per month in 12.3% (76/617) (missing data excluded). Only 8.3% (54/648) of migraine patients were currently taking prophylactic medication. Patients reporting three or more migraines or two migraines per month were significantly more likely to be taking prophylactic medication (19.7% and 25.0%, respectively) than those with less frequent migraine attacks (3.8%) (P < 0.0001). Prophylactic medication had been used previously by 15.0% (96/640). The most common prophylactic agents used currently or previously were pizotifen and propranolol; other appropriate agents were rarely used, and inappropriate use of acute medications accounted for 9% of "prophylactic treatments". Four in five migraine patients were currently using acute medication as required for migraine, and 60.6% of these medications conformed with recommendations of the National Prescribing Service. However, non-recommended drugs were also used, including opioids (38% of acute medications). Migraine is recognised frequently in Australian general practice. Use of acute medication often follows published guidelines. Prophylactic medication appears to be underutilised, especially in patients with frequent migraine. GPs appear to select from a limited range of therapeutic options for migraine prophylaxis, despite the availability of several other well documented efficacious agents, and some use inappropriate drugs for migraine prevention.

Background: Virtual reality offers a potential way to facilitate amplified forms of meditation and distraction, potentially inducing greater states of stress and pain reduction. It is an intriguing possibility that VR-based meditation could disrupt migraine neurophysiology. Objective: We aimed to explore the feasibility, usability, and potential benefits of home-based virtual reality-delivered meditation as a non-pharmacological adjunct in migraine management. Methods: A multiple baseline replicated Single-Case Experimental Design using an A-B-A (A1-Baseline, B-Intervention, A2-Follow-up) procedure was employed. Two participants underwent serial observations before, during, and after an intervention involving brief daily meditations at key points relevant to migraine onset and peak. Systematic visual analysis of the data was supported by secondary Tau-U statistical analysis. Results: Visual analysis suggested no apparent change in pain intensity and migraine frequency across the study. The Tau-U index supported this finding, confirming that pain reports were non-phase-dependent (all ps &amp;gt;0.4). Adherence to the daily meditation was high (&amp;gt;89%), but adherence to meditations at onset and peak pain was low (0-43%). Both participants reported high System Usability Scale scores (&amp;gt;80/100). Implications: While it is premature to exclude a role for virtual reality meditation in migraine management in specific individuals, this case series provides no support for a potential benefit although utility in some individuals cannot be ruled out by the current design. Moreover, we highlight potential issues related to implementing VR-based interventions in groups experiencing migraine pain, particularly regarding protocol adherence at migraine onset and peak pain. Plain language summary: We aimed to explore the feasibility, usability, and potential benefits of home-based virtual reality-delivered meditation as a non-pharmacological adjunct in migraine management. A multiple-baseline replicated single-case experimental design was used, involving two females with medically diagnosed migraines. No support for a potential benefit of virtual reality-based meditation was found, although its utility in some individuals cannot be ruled out by the current design.

BackgroundMigraine is a debilitating neurological condition often impacting the quality of life and resulting in physical, emotional, and social burdens. Pharmaceutical interventions are the conventional treatment for migraine; however, behavioral interventions provide safe alternatives. Both mindfulness meditation and neurofeedback are behavioral interventions that have been separately studied for migraine treatment. To date, no studies have investigated neurofeedback-assisted mindfulness meditation for migraine treatment and prevention.ObjectiveThe objective of our study was to document the experiences of individuals with migraines who participated in an 8-week neurofeedback-based mindfulness meditation intervention as part of a randomized controlled trial.MethodsSemistructured interviews were undertaken with 10 participants (7 female and 3 male participants) aged 23 to 55 years who had previously completed an 8-week neurofeedback-based mindfulness meditation program using Muse wearable sensory headbands as part of a randomized control trial. The interview data were analyzed using reflexive thematic analysis.ResultsParticipants spoke to 3 categories of experiences: the positive impact of neurofeedback-based mindfulness meditation on migraine experiences, enhanced well-being and improved quality of life resulting from the intervention, and the benefits and drawbacks of incorporating a portable electroencephalogram technology into mindfulness meditation practices in the context of migraine treatment. In total, 9 participants felt that their ability to manage migraine symptoms was improved, and all participants expressed benefits beyond migraine prevention and pain management. Participants also spoke to the interconnectedness of migraine symptoms, daily stressors, and the framing of lived experience.ConclusionsNotably, as the first study to evaluate the experiences of individuals with migraines using an at-home, neurofeedback-based mindfulness meditation intervention, this investigation adds to our understanding of nonpharmaceutical migraine treatment. Participants reported that this neurofeedback-based mindfulness meditation intervention improved migraine management, leading to significant reductions in pain intensity, migraine frequency, and medication use. They also described improved quality of life and emotional regulation related to this intervention, which they attributed to enhanced attentional control and body awareness. This research supports the consideration of neurofeedback-based mindfulness meditation interventions using emerging technologies, such as wearable electroencephalogram devices, as an accessible behavioral intervention for migraine management.

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