Intended for healthcare professionals

Clinical Review State of the Art Review

Complementary and integrative medicine in the management of headache

BMJ 2017; 357 doi: (Published 16 May 2017) Cite this as: BMJ 2017;357:j1805
  1. Denise Millstine, director and consultant1,
  2. Christina Y Chen, senior associate consultant2,
  3. Brent Bauer, director of research3
  1. 1Integrative Medicine Section, Department of General Internal Medicine; Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ 85260, USA
  2. 2Primary Care Internal Medicine, Division of Geriatrics, Mayo Clinic, Rochester, MN 55905 USA
  3. 3Integrative Medicine Program, Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
  1. Correspondence to: D Millstine Millstine.Denise{at}


Headaches, including primary headaches such as migraine and tension-type headache, are a common clinical problem. Complementary and integrative medicine (CIM), formerly known as complementary and alternative medicine (CAM), uses evidence informed modalities to assist in the health and healing of patients. CIM commonly includes the use of nutrition, movement practices, manual therapy, traditional Chinese medicine, and mind-body strategies. This review summarizes the literature on the use of CIM for primary headache and is based on five meta-analyses, seven systematic reviews, and 34 randomized controlled trials (RCTs). The overall quality of the evidence for CIM in headache management is generally low and occasionally moderate. Available evidence suggests that traditional Chinese medicine including acupuncture, massage, yoga, biofeedback, and meditation have a positive effect on migraine and tension headaches. Spinal manipulation, chiropractic care, some supplements and botanicals, diet alteration, and hydrotherapy may also be beneficial in migraine headache. CIM has not been studied or it is not effective for cluster headache. Further research is needed to determine the most effective role for CIM in patients with headache.


  • We are grateful for the assistant of Diana Almader-Douglas, staff medical librarian at Mayo Clinic and (Margaret) Alice McKinney, medical illustrator at Mayo Clinic, for graphic design of figures.

  • Contributors: DM was primary author of the article. CYC contributed to the revision of the traditional Chinese medicine section and graphics. BB was supervising senior author. All authors reviewed and agreed upon the final version.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: none.

  • State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors.

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