Non-pharmacological approaches to migraine management

Migraine is a prevalent and socially significant neurological disorder that requires a comprehensive approach to both treatment and prevention. Non-pharmacological methods of migraine prevention are discussed. Particular attention is given to behavioral and lifestyle interventions such as trigger management, sleep and dietary hygiene, regular aerobic exercise, weight control, and cognitive-behavioral therapy (CBT). These approaches form the basis of non-pharmacological tactics in routine practice. In addition, methods targeting the neurobiological mechanisms of migraine are reviewed, including acupuncture, nutraceuticals (magnesium, riboflavin, coenzyme Q10, vitamin D, etc.), dietary interventions (ketogenic and DASH diets), and non-invasive neuromodulation (high-frequency transcranial magnetic stimulation, transcranial direct current stimulation, trigeminal and vagus nerve stimulation, and remote electrical neuromodulation). Non-pharmacological prevention significantly broadens the therapeutic arsenal for migraine. However, key challenges remain in the standardization of neuromodulation protocols, harmonization of outcome measures and follow-up durations, and validation of nutraceutical efficacy. In clinical practice, the most consistent preventive outcomes are achieved through an individualized approach emphasizing lifestyle modification, patient education, and CBT. A comprehensive approach is considered a promising strategy for managing patients with migraine. The synergistic effect of combining behavioral, physical, and instrumental techniques exceeds the results of their isolated use, making a comprehensive multimodal approach the most promising and reasonable tactic for achieving sustainable control over migraine, minimizing disability, and improving patients’ quality of life in the long term.

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