Nonpharmacological Self-Management of Migraine Across Social Locations: An Equity-Oriented, Qualitative Analysis

Abstract

Background: Migraine is a disabling neurological disorder and the sixth biggest cause of disability worldwide. The World Health Organization has declared migraine a major public health problem due to a paucity of knowledge about cause and effective treatment options. Both in incidence and severity, migraine disproportionately affects people occupying marginalized social locations (SL). Managed pharmacologically, migraine is treated with daily preventive and as-needed abortive medications. Both come with high literal and figurative costs: intolerable side effects, medication interactions, and prohibitive prices. Cost prohibitive, ineffective, and unsustainable pharmacological treatment options have contributed to high levels of interest in complementary approaches by people with migraine, but little is known about their motivations, patterns of use or access, or how these may vary by SL. Method: We conducted focus groups with 30 people with migraine to explore their desires and recommendations for migraine clinicians and researchers. We used qualitative content analysis to identify themes. Outcomes: We identified 4 themes: a more holistic, collaborative, long-term treatment approach; medication as a shortterm solution; high personal and economic costs of medication; and desire for more information and access to natural approaches. Across SL, participants expressed keen interest in integrative approaches and wanted better access to complementary modalities. Participants in marginalized SL described reliance on traditional/folk remedies, including engagement with family and community healers, who they described as more affordable and culturally accessible. Conclusions: Holistic and integrative approaches were preferred over medication as long-term migraine management strategies. However, people in marginalized SL, while disproportionately disabled by migraine, did not feel as comfortable accessing integrative approaches through currently available channels. Engaging with these communities and using a critical lens to explore barriers to access can develop options to make complementary modalities more approachable, while also attending to systemic blind spots that may unintentionally alienate socially marginalized groups.

A qualitative evidence synthesis of patient perspectives on migraine treatment features and outcomes

“…30,32 In both studies that report on finding preferences for SDM, patients reported a need for information from clinicians about migraine as a condition as well as about treatment options. 26,30 In one of these studies, patients reported the absence of SDM where insurance or health system changes excluded them from clinicians or treatments they may have worked to find (quote 1.20). 31 In other study, patients reported absence of SDM where they perceived low or lack of provider knowledge about migraine (quote 1.21).…”

“…29 In some studies of medications, where non-pharmacologic treatment options were not selected, patients acknowledged their need for medication along with expressing a desire to use less medication or find non-drug treatment options. 26 In one study of non-pharmacologic treatment for migraine, all study participants took some sort of medication for migraine. They acknowledged the need for this, but repeatedly expressed a desire to use non-pharmacological approaches for prevention, long-term migraine reduction, and contributions to overall health (quote 2.4).…”

“…They acknowledged the need for this, but repeatedly expressed a desire to use non-pharmacological approaches for prevention, long-term migraine reduction, and contributions to overall health (quote 2.4). 26 Another study found that some patients, especially women considering pregnancy, were dissatisfied with a perceived emphasis on drug therapy (quotes 2.5, 2.6, and 2.7). 34 Patients in a study exploring the opinions, motives, and expectations of patients regarding prophylactic therapy described how using daily preventive pills would make them feel emotionally unhealthy (quote 2.8).…”

“…23 There was also one study that reported patients not convinced that their medications were effective (quotes 2.12 and 2.13). 26 3. Rapidity of action Only one study of intravenous (IV) medication in the ED, touched on rapidity of action.…”

Multimodal chiropractic care for migraine: A pilot randomized controlled trial

“…Although medications are often used as first-line treatments for migraine, some patients experience intolerable side effects and may have increased risk for migraine chronification (1,2). As a result, individuals with migraine often express interest in holistic or integrative approaches over medication alone as part of a long-term management strategy (3). Integrative treatment approaches that address pathophysiologic processes involved in migraine attacks and/or reduce migraine symptoms have potential to reduce migraine frequency and severity.…”