Migraine is a neurological disorder characterized by severe headache attacks greatly affecting patients’ quality of life and work performance (1). Complementary and alternative medicine (CAM) is defined as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine (2). Migraine patients usually require long-term treatment due to frequent attacks or a chronic course of the disorder (1). As in other chronic illnesses (2–4), migraine sufferers often turn to CAM, either alongside or instead of conventional medical treatment. Based on published data so far, over 40% of adults with migraine use complementary and alternative medicine (5–7). Although CAM for migraine is widely used in real life, there is limited research on its effectiveness and safety, as well as patients’ perceptions of these treatments (5). Only a fraction of CAM methods used in migraine have scientific evidence and are recommended by the German Migraine and Headache Society and the German Society of Neurology (those include acupuncture, biofeedback and aerobic-physical exercise). Others, including homeopathy, reflexological massage, piercings and elimination diet, lack evidence and are typically not recommended (8). Thus, it is imperative for medical specialists to understand patients’ perspectives on CAM for migraines to better guide their treatment. Without proper management, CAM might also pose unforeseen dangers. For example, butterbur, that is used as an alternative treatment for migraine prevention, can predispose liver toxicity, allergic reactions (9). Cannabis use could result in substance abuse related problems, exacerbation of psychotic disorders, mood disorders, neurocognitive impairments (10). Fasting and diets, could result in nutritional imbalances (11, 12) and strenuous unmonitored physical exercise, especially, for former sedentary individuals with cardiovascular diseases, can cause acute cardiac events (13). Despite this, in comparison to conventional medical treatment, CAM is often perceived by society as safer and more “natural” (14). Such thinking might lead more concerned patients to substitute standard migraine care, potentially resulting in a higher rate of treatment failure.

This cross-sectional study aims to identify CAM prevalence among migraineurs in Lithuania, reasons, migraine related and personality factors influencing its utilization, and examine its impact on patient compliance with conventional physician-prescribed treatments.

Our study revealed that in the past year, a half of migraine sufferers in our sample used CAM. Respondents predominantly chose physical activity, dietary changes, and relaxation techniques. Although cannabis was not a popular option in our study, it is worth noting that non-legal status of some cannabis substances (those with tetrahydrocannabinol content more than 0.20%) in Lithuania could impact the data, potentially resulting in underreporting. Among the three most common patient-reported reasons for CAM usage, ineffectiveness of conventional medicines was reported. However, the primary reason for choosing CAM was a fear that conventional medicines might be harmful. CAM users also perceived CAM as more natural and safer compared to conventional migraine treatment and had more concerns about food safety compared to non-users. In addition, respondents with more severe symptoms, using preventive medication and requiring frequent sick leaves, were more likely to use CAM. Interestingly, we found that CAM use was more frequent among patients with more severe symptoms, as well as among preventive medicine users. This could be explained by limitations of our survey—as data on CAM usage spanned a 12-month period (“Have you used CAM during the last 12 months?”), while information on preventive medication was collected at the time of the survey (“Do you use any preventive medications?”). Consequently, accurately evaluating the relationship between CAM and preventive medication is not feasible. For example, some respondents might have used CAM alongside preventive medication due to perceived harm or dissatisfaction with conventional medicines. Others may have transitioned to preventive medication after finding CAM ineffective. In our study, the predominant personality trait of openness was associated with CAM use, especially for those choosing relaxation techniques or meditation, cannabis and massage/osteopathy/chiropractic. Respondents who take personal responsibility for their health were more likely to choose relaxation techniques or meditation.

Very similar prevalence findings to ours were previously recorded in the United States of America, where CAM was used by approximately half of migraine or severe headache sufferers (5). A systematic review of CAM utilization in neurological disorders indicated an average use of 61.6% in headaches, however, this number highly varied between studies (from 32% to 84.75%) (22). Our respondents predominantly chose physical activity, dietary changes, and relaxation techniques as preferred CAM types. This is in line with common recommendations for migraine prevention, advocating for relaxation methods, biofeedback and regular aerobic activity (8). Other CAM types, such as Mediterranean, low sugar or low carbohydrate diets, were also reported to be beneficial for general well-being and disease prevention (23, 24). Our results contradict the findings of a previous systematic review reporting traditional Chinese medicine, thermotherapy, herbal medicine and massage to be the most commonly used CAM groups by headache sufferers (22). However, it is noteworthy that this review included 6 studies with mixed headache types from different world regions (Kuwait, Turkey, USA, and United Kingdom), which could explain the data discrepancy. Nevertheless, there is still a fraction of our respondents using low-scientific-evidence CAMs, such as fasting, ketogenic diet, cannabis, oral therapies, reflexological massage and others. Beyond lacking evidence, some reports suggest these methods may even have a reverse, migraine triggering effects (8, 25–28).

A recent systemic review on neurological disorders, including multiple sclerosis, headache/migraine, stroke and epilepsy, have identified the main reasons for using CAM. These encompass a hope for symptom relief, a desire to “try everything that is possible “and a dissatisfaction with current medical treatments in terms of their effectiveness and side effects (22). Notably, this review underscores a general inclination toward CAM over conventional treatments (22). Similarly, in our study respondents pointed ineffectiveness of conventional medicines as one of the reasons for using CAM. In addition, respondents with more severe symptoms, requiring frequent sick-leaves were more likely to use CAM which could imply the need to “strengthen” ineffective treatments.

Our data also suggests that CAM use might be associated not only with the actual ineffectiveness and side effects of conventional medicines but also with opinions regarding their potential harm – the primary motivation for selecting CAM was the fear of potential harm from conventional treatments, in addition, CAM users perceived CAM as more natural and safer than conventional medicine. One of the possible explanations for this could be a belief that conventional medication is “more chemical,” unnatural, and thus, more harmful. It could also suggest that there is a lack of education on standard medicine provided to patients. An interesting finding was also that only 48.99% of CAM users reported this use to their doctors. This could point to poor doctor-patient relationships. A common reason for such non-disclosure might be a fear of a negative reaction or simply due to the doctor’s indifference toward CAM—a phenomenon which was previously reported (29). It is important to emphasize that the lack of communication could result in CAM users switching from conventional medicine to CAM, as conventional medicine is associated with more harm, side effects and ineffectiveness, while CAM is thought to be safe and natural. Unfortunately, research on this topic is limited. Some findings from epilepsy studies suggest that the use of CAM could be associated with medication non-adherence (30, 31). To note, there was no association in our study of CAM use with non-compliance with standard medicine. For optimal migraine management, healthcare providers should encourage evidence-based CAM approaches but remain cautious about possible harms (8). Finally, considering the somewhat limited training on CAM for headaches (32), improvements in medical education are also necessary. There is also a need for more extensive studies regarding the impact of CAM use on patient adherence to conventional physician-prescribed treatments, the implementation of educational programs focusing on providing evidence-based information about CAM modalities for migraine, promoting open communication between patients and providers regarding CAM use, and emphasizing the importance of integrating CAM into a comprehensive migraine management plan, barriers to discuss CAM with healthcare providers.

To our knowledge, it is the first study analyzing CAM use for migraine and its possible connection with psychological traits, personal views and disease-specific characteristics. However, this study has some limitations. Firstly, the generalizability of our results is limited. Our chosen means of online survey distribution could have contributed to lack of sampling, sampling bias (selecting for younger, better educated, digitally literate, more social respondents, respondents with access to the Internet and thus potentially people with greater access to CAM information), non-population distribution of the group with female predominance which could be in part explained by gender response tendencies to online surveys (33, 34). In fact, greater female participation is even seen in modern migraine randomized controlled trials (35). Secondly, migraine characteristic could be better evaluated by acquiring number of days with headache, number of days with migraine, special questionnaires would more thoroughly reveal migraine burden (for example The MIDAS (Migraine Disability Assessment) questionnaire). Thirdly, some of the compared factors divided into smaller groups resulted in relatively small sample sizes, which could have lowered the statistical power to detect differences between groups. We also acknowledge that relying on self-reported migraine diagnosis, is a limitation of our study, a questionnaire designed according to International Classification of Headache Disorders criteria would better distinguish patients with migraine diagnosis. Lastly, we assessed treatment adherence with self-reported single-choice question, which could have overestimated adherence.

Our study reveals a high prevalence of CAM use among migraine patients. The most utilized CAM groups include physical activity, dietary changes and fasting, relaxation, and meditation. A significant number of patients turn to CAM due to dissatisfaction with conventional treatment effectiveness, concerns of adverse effects, or fears of its potential harm. The decision to try CAM depends on multiple factors, including migraine severity and if effect on personal wellbeing, psychological factors and personal views. Alarmingly, only less than a half of CAM users admitted this use to their doctors, which might result from anticipated negative reactions. Therefore, doctors need to improve patient education regarding conventional medicines, address emerging concerns and foster open discussions about alternative medicine, thus ensuring a holistic approach to migraine care.

The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding author.

Ethics approval for this study was not required in accordance with the Vilnius Regional Biomedical Research Ethics Committee, as the received data were non-identifiable (General Data Protection Regulation Principle 26). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required from the participants or the participants’ legal guardians/next of kin in accordance with the national legislation and institutional requirements because the survey was anonymous and entirely voluntary.

GM: Data curation, Formal analysis, Methodology, Visualization, Writing – original draft, Writing – review & editing. AD: Writing – review & editing. KR: Conceptualization, Data curation, Methodology, Supervision, Visualization, Writing – review & editing.