P-047 - (Poster #47) Complementary Health Approach Engagement of People with Migraines in a Nationally Representative Sample

Background: Migraine is a prevalent and disabling neurological disorder, affecting approximately 12% of the global population. It ranks among the leading causes of years lived with disability worldwide, particularly among individuals in their most productive years. Although conventional pharmacologic treatments — including triptans, CGRP inhibitors, and preventive medications — form the cornerstone of migraine management, many patients remain dissatisfied due to suboptimal efficacy, medication overuse, or undesirable side effects. Consequently, a substantial subset of individuals with migraine turn to complementary health approaches (CHAs), which span nutritional strategies, mind-body therapies, manual modalities, and integrative systems-based care.
Despite growing public interest and increasing integration of CHAs into healthcare landscapes, limited data exist on their specific use patterns, therapeutic expectations, and perceived outcomes among migraine sufferers. Existing literature suggests that individuals with chronic or recurrent conditions are more likely to engage with CHAs, but migraine-specific data remain sparse. This knowledge gap impedes clinicians’ ability to counsel patients effectively and to align care with evolving patient preferences.



Purpose/Objectives: This study aimed to examine how individuals with migraines differ from non-migraine counterparts in their use of CHAs, positive expectancy of untried modalities, and favorability of experience for CHAs previously used. We sought to identify which specific CHA categories were most utilized and perceived as helpful while adjusting for relevant social and demographic covariates. Insights from this analysis can inform more personalized approaches to integrative, patient-centered migraine management.

Methods: A secondary analysis was conducted using a cross-sectional, quota-controlled online survey of 3,022 U.S. adults, matched to national census data by sex, age, race/ethnicity, education, and geography. Migraine status was self-reported via physician diagnosis within the past year. CHA exposure, expectations, and experiential satisfaction were assessed across five major categories of CHA: nutritional, physical, psychological, combined psychological/physical, and system-based. Responses were dichotomized for analysis. Bivariate comparisons between migraine and non-migraine groups were performed using chi-square tests. Multivariate logistic regression models were constructed to estimate associations between migraine status and each CHA variable, controlling for age, race, sex, community size, education, income, BMI, insurance, and geographic location. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were reported. Listwise deletion was used for missing data. Statistical significance was defined by CIs excluding 1.0 and p = < 0.05.

Results: The adjusted logistic regression showed that those experiencing migraines have significantly higher odds of trying at least one form of CHA (aOR=4.84, 95% CI 2.58-9.07). This relationship extended to each of the subcategories of CHA analyzed: Nutritional (aOR=1.60, 95% CI 1.25-2.04), Physical (aOR=1.84, 95% CI 1.52-2.23), Psychological (aOR=1.50, 95% CI 1.21-1.85), Combined (aOR=2.04, 95% CI 1.62-2.57), and System based (aOR=1.78, 95% CI 1.39-2.29). The specific modalities that exhibited the highest odds of use by those with migraines included osteopathic manipulation (aOR=2.39, 95% CI 1.56-3.67), chiropractic (aOR=2.31, 95% CI 1.81-2.94), spiritual healing (aOR=2.31, 95% CI 1.68-3.16), and naturopathy (aOR=2.21, 95% CI 1.56-3.14)
Positive expectations of at least one CHA participants hadn’t utilized were not significantly different in those with and without migraines. However, select CHAs exhibited lower positive expectancy by the migraine group, including homeopathy (aOR=0.79, 95% CI 0.66–0.96), herbalism (aOR 0.78, 95% CI 0.65-0.95), non prescription diet (aOR=0.79, 95% CI 0.65-0.97) prayer (aOR=0.55, 95% CI 0.38-0.78), and naturopathy (aOR=0.78, 95% CI 0.65-0.95). Those with migraines who had not used any nutritional CHA had a lower positive expectancy associated with them (aOR=0.76, 95% CI 0.63-0.91).

Favorable experiences with previously used CHAs were significantly different in the migraine group for several modalities. Those experiencing migraines who had used at least one nutritional CHA generally found them less favorable (aOR 0.72, 95% CI 0.53-0.98), with the exception of homeopathy (aOR=3.90, 95% CI 1.22–12.52). Device-based therapies, excluding light, magnetic, or electrical stimulation, were associated with less favorable experience in those with migraines (aOR=0.34, 95% CI 0.13-0.92). Naturopathy was notable as having a much higher association of favorable experience among those with migraines (aOR=8.08, 95% CI 2.56–25.51). 



Conclusions/Implications for future research and/or clinical care: Individuals with migraine demonstrate significantly greater engagement with a wide range of complementary health approaches compared to those without migraine, suggesting a pronounced inclination toward integrative or alternative care pathways. Notably, this elevated use spans all major CHA domains, with especially high odds observed for physical and system-based modalities such as osteopathic manipulation, chiropractic care, and naturopathy.
Despite high utilization, expectations and experiential satisfaction with specific CHAs were more nuanced. Migraine sufferers expressed lower positive expectancy and satisfaction for several common interventions, including nutritional and device-based therapies, while showing disproportionately favorable experiences with modalities such as homeopathy and naturopathy. Future randomized, controlled trials could evaluate clinical outcomes among patients with migraine headache using one or more of the most often used CHAs identified in our study. 

These findings underscore the importance of nuanced, patient-centered dialogue around CHA use in migraine care. Clinicians should be aware of the high prevalence of CHA engagement in this population and the varied expectations and outcomes associated with different modalities. Improved understanding of these patterns may inform more tailored, integrative treatment planning and promote evidence-aligned recommendations for patients seeking alternative or adjunctive care.