Migraine

What is Migraine?

Migraine is a genetically influenced neurological disorder marked by recurring attacks of moderate to severe headache, often with nausea and sensitivity to light and sound.^[1] It is a common cause of disability and lost work.^[1]

Common symptoms

A typical attack involves headache on one side that throbs, gets worse with activity, and lasts from 4 to 72 hours. Nausea, light sensitivity and sound sensitivity are common.^[1]

Migraine with aura brings fully reversible symptoms, such as visual changes, that last minutes and usually come before the headache. Most people, about 75 percent, have migraine without aura.^[1] Chronic migraine means headache on 15 or more days a month for more than three months.^[1]

Causes and risk factors

The cause is multifactorial, with genetic influence. Spreading waves of altered brain activity are thought to cause aura and may also trigger the nerve pathways that produce the headache pain.^[2] Depression, epilepsy, stroke and heart attack are more common in people with migraine.^[2]

Triggers vary by person. Stress, sleep changes, diet and physical activity are associated with attacks, although the links differ from one person to the next.^[3]

How it is diagnosed and treated conventionally

Diagnosis is based on your history and the pattern of attacks, using criteria from the International Headache Society.^[1] Tests are mainly used to rule out other causes when something is unusual.

Mild attacks are treated with pain relievers or anti-inflammatory drugs, and moderate or severe attacks with triptans. Newer options include gepants and lasmiditan for attacks.^[2] For frequent attacks, preventive options include antibodies targeting CGRP and some gepants. OnabotulinumtoxinA may help chronic migraine, and several neuromodulation devices are approved.^[2] Lifestyle management is considered a mainstay of treatment alongside medication.^[3]

Why Migraine calls for a whole-person approach

Migraine is driven by the nervous system, but attacks are shaped by many factors that differ between people. A plan that looks at sleep, stress, diet and daily habits, in addition to medication, matches what the research describes.^[3]

The factors below are those that complementary care may be able to support. They are not a substitute for diagnosis or prescribed treatment.

Stress

Stress is one of the lifestyle factors linked to the occurrence of migraine attacks.^[3] In a trial of 89 adults, an eight-week mindfulness program did not reduce migraine days more than headache education, but it did improve disability, quality of life and depression scores.^[4]

Sleep

Sleep patterns are among the lifestyle factors associated with attack occurrence, and steady sleep is a common part of migraine self-care.^[3]

Pain processing

Researchers describe a heightened sensitivity of the pain pathways in the brain and nerves, known as central sensitization, in chronic pain conditions generally.^[5] This is one reason acupuncture has been studied for pain.

Mood and other conditions

Depression is more common in people with migraine, so mood deserves attention as part of care.^[2]

Acupuncture for Migraine

What the research shows

Research suggests acupuncture can reduce the number of migraine attacks, although its benefit over sham acupuncture is small. A Cochrane review of 22 trials with 4,985 people found moderate-quality evidence that adding acupuncture to routine attack treatment reduced headache frequency compared with no acupuncture. After treatment, headache frequency at least halved in 41 percent of people receiving acupuncture and 17 percent receiving none.^[6]

The same review found a small but statistically significant benefit over sham acupuncture, with at least a 50 percent reduction in 50 percent of people on real acupuncture and 41 percent on sham. It also found acupuncture may be at least similar to preventive drugs, with fewer side effects. The review noted that studies longer than one year are lacking.^[6]

Newer trials point in the same direction. In a 2020 trial of 150 people with episodic migraine, 20 sessions of real acupuncture reduced migraine days more than sham acupuncture or usual care.^[7] A 2017 trial of 249 people found a larger drop in attacks with true than with sham acupuncture at 16 weeks.^[8] A trial of 480 people found that the benefit over sham acupuncture was statistically significant but clinically minor.^[9]

A 2025 meta-analysis of 23 trials found that acupuncture reduced migraine days, attack duration and improved quality of life compared with sham, with the authors noting potential bias.^[10] A 2021 trial sequential meta-analysis agreed that it was better than sham, and said more trials are needed.^[11]

For attacks that have already started, a 2023 review of 21 trials found that acupuncture may be more effective than sham for pain at two hours, but the certainty of the evidence was low to very low.^[12] People in sham-controlled trials also improve a good deal, with a pooled response rate of about 34 percent to sham acupuncture.^[13]

How acupuncture may work

Researchers propose that acupuncture strengthens the nervous system's pain-inhibiting pathways, lowers local inflammatory signals and changes how pain is processed in the spinal cord and brain.^[5] These are proposed explanations and have not been confirmed in people with migraine.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, with points that may include the head, neck, hands and legs. We reassess after a short course of visits. The three larger trials above used 20 sessions over 4 to 8 weeks.^{[7, 8, 9]}

Serious problems are rare. In prospective studies about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000.^[14] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Migraine

The Ayurvedic view

Ayurveda describes migraine-type headache as Ardhavabhedaka, a one-sided headache linked to disturbance of the doshas, especially Vata and Pitta. These are traditional categories used to plan care, not biomedical diagnoses.

Therapies that may be used

Care is individual and traditionally combines:

• Diet and daily routine, such as regular meals, steady sleep hours and attention to personal triggers
• Warm oil treatments for the head and neck, such as head massage
• Herbs chosen by a qualified practitioner, taking your medicines into account
• Nasya, medicated nasal drops, and other Panchakarma procedures only in selected cases

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and it should not be started until a physician has checked that your headaches are migraine. Herbal preparations applied to the skin (transdermal medication therapy) may also be used.

What the research shows

The research on Ayurveda for migraine is limited. A narrative review of 12 clinical studies, including six randomized trials, found that most reported benefit, mostly with herbal or herbo-mineral formulas and Panchakarma procedures. The authors noted small samples, short follow-up and weak outcome measures.^[15]

We did not find a large placebo-controlled trial of Ayurvedic treatment for migraine. These studies cannot show that Ayurveda is effective, and in one study of Ayurvedic products bought online, products made by the rasa shastra practice of combining herbs with metals and minerals more often contained detectable metals than other products (about 41 percent versus 17 percent).^[16]

Herbal medicine for Migraine

Herbs and formulas that have been studied

Herbs that have been tested in randomized trials include feverfew, butterbur, curcumin from turmeric, coriander, citron, chamomile, lavender and peppermint or menthol oil.^[17] Curcumin is also traditional in Ayurveda.

What the research shows

The evidence is limited and mixed. A systematic review of 19 randomized studies found mixed results for feverfew and positive but limited evidence for butterbur. It found preliminary positive findings for curcumin, citron and coriander as preventives, and for menthol and chamomile for acute attacks, but the risk of bias was high in many studies.^[17]

A 2025 review says feverfew may help prevent migraine, though safety data are unclear and preparations differ. It rates the evidence for butterbur as strong but warns of liver toxicity.^[18] Because of the liver concern, butterbur is a herb to discuss carefully with your physician before any use.

Safety and herb-drug interactions

Herbs are active substances. Herbal and dietary supplements are a recognized cause of liver injury.^[19] Tell us about all medicines you take, including preventive migraine drugs, blood thinners and blood pressure medicines, and whether you are pregnant or breastfeeding or have liver or kidney disease.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[16] Herbs should come from tested sources and be prescribed individually.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes migraine as rising liver yang, wind or blocked qi and blood in the head channels. Researchers studying acupuncture look at pain-inhibiting pathways, inflammation and central sensitization.^[5] Researchers studying migraine focus on spreading cortical activity and trigeminal nerve activation.^[2]

Ayurveda's aggravated Vata and Pitta describe a throbbing, one-sided headache with sensitivity. No study has shown that a dosha or a TCM pattern corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for migraine is complementary. Keep your physician or neurologist, and do not stop or change prescribed medicines, including preventive medicines, without your prescriber. We do not diagnose the cause of headaches, so new or changing headaches should be medically evaluated first.

Please bring your diagnosis, a full list of medicines and supplements, a headache diary if you keep one, and any imaging results.

When to seek urgent medical care

Some headaches signal a serious problem and need prompt evaluation.

• A sudden, severe "thunderclap" headache, or the worst headache of your life
• Headache with fever, a stiff neck, confusion or a rash
• Headache with weakness, numbness, trouble speaking, vision loss or fainting
• Headache after a head injury
• A new type of headache, or a pattern that changes, especially after age 50
• An aura that lasts more than an hour, or a headache lasting more than 72 hours

If any of these occur, call 911 or go to the nearest emergency department.