A Patient perspective of Complementary and Integrative Medicine (CIM) for Migraine Treatment: A social media survey

A Patient perspective of Complementary and Integrative Medicine (CIM) for Migraine Treatment: A social media survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article A Patient perspective of Complementary and Integrative Medicine (CIM) for Migraine Treatment: A social media survey Deena E Kuruvilla, Amit Mehta, Nidhi Ravishankar, Robert Cowan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-25263/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract OBJECTIVE: To survey persons with migraine who use social media about Complementary and Integrative Medicine (CIM) for the treatment of migraine. BACKGROUND: CIM encompasses medical treatments that are not part of ,but are used in concert with, mainstream medicine. Between 28–82% of people with migraine use non-drug approaches, and approximately 50% of people with migraine do not discuss non-drug treatments with their healthcare providers (HCPs) 9 . it is important for providers to be conversant with CIM treatments and the available evidence-based data. To further this effort, the Complementary and Integrative Medicine Special Interest Section (CIMSIS) of the American Headache Society surveyed migraine patients directly through social media to identify CIM practices in which they engage. METHODS: In collaboration with the American Migraine foundation (AMF) and Yakkety Yak, a digital marketing agency, we posted a 17-question survey on the Move Against Migraine (MAM) Facebook group, which has 20,000 + members. The goals of the survey were to assess the attitudes toward CIM among this group, to identify which CIM modalities are being used and to determine what patients considered to be the most effective CIM modalities. While Yakkety Yak posted the survey link on the group page, the survey itself was hosted on Qualtrics, a confidential survey service. Qualtrics provides tools to configure survey properties and to customize privacy settings, so respondents cannot be tracked to an IP or email address, name or ticket number, which allows for anonymous responses. Our study was submitted for review to the IRB (institutional review board) and was exempted. RESULTS: 372 MAM members (approximately 2%) responded to the questionnaire, of which 335 reported using CIM; between 114–139 (34–42%) found CIM modalities to be at least mildly effective. Of note, 164 (49%) reported using cannabis derivatives or cannabinoids, specifically with, 64/164 (39%) reporting that cannabis was not effective for them. CONCLUSIONS: This study provides an initial investigation into the demographic and practice patterns of patients who use CIM. While it must this sampling may not reflect CIM use across all individuals with migraine, it does strongly suggest the need for better education on the role of, and evidence for, CIM among headache care providers, and the need to ask patients specifically about their use of and interest in CIM. Neurology Integrative medicine alternative medicine headache migraine social media survey Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction: Migraine affects 1 out of every 7 Americans annually and is 2 to 3 times more common in females than males 1 . The financial burden of migraine in the United States is estimated to be $ 1,533 per patient annually for episodic migraine and $ 4,144 for those with chronic migraine. Costs are higher in vulnerable or underserved populations, such as those who have low socioeconomic status, the uninsured, and the unemployed 1 . While new migraine preventive and abortive treatments emerging, research shows that a significant percentage of our patients are looking beyond standard medical treatments and incorporating complementary and integrative medicine (CIM). According to epidemiological studies, 28–82% of people with headache use CIM approaches 6 , 7 , 8 , while 50% of people with headache do not discuss their CIM treatments with their healthcare provider 6 . CIM is defined by the National Center for Complementary and Integrative Health (NCCIH) as treatments that are separate from mainstream medicine but may be integrated with it 6 . NCCIH was previously called the National Center for Complementary and Alternative medicine (NCCAM) but was changed to NCCIH based on the escalation in use of complementary approaches by Americans. NCCIH more accurately reflects that Americans are no longer using these approaches “alternatively” but rather in conjunction with mainstream medicine. 6 Examples of CIM are commonly divided into two main categories: Natural products (herbs, vitamins, minerals and probiotics) and mind-body practices (yoga, chiropractic, meditation and massage therapy) 6 9 , 10 . Each category is further divided into a subcategory of CIM with meditation/yoga, herbal therapies, massage/chiropractic, and acupuncture being the top CIM in each category, respectively. In 2012, the National Health Interview Survey reported on 88,962 American adults and 17,321 children and found 33.2% of adults and 11.6% of children used CIM in the previous 12 months 7 . Additionally, Americans spent $ 30.2 billion on complementary health approaches during the same period 7 . Educated women with migraine are more likely to use CIM 8 . Wells et al., using the 2007 National Health Interview Survey (n = 23,393) compared CIM use between adults with and without migraine/severe headache 9 . 49.5% of patients with migraine/severe headache used at least 1 Integrative treatment in the previous 12 months compared to 33.9% of patients without migraine/severe headache. Researchers noted that adults with migraine/severe headache used CIM more often for treatment because: their provider recommended it, mainstream treatment was ineffective, or mainstream and/or mainstream treatment was too expensive 9 . Similarly, Rhee et al. used the 2012 National Health Interview Survey to estimate the prevalence rates of CIM use in adults with migraine/severe headache (n = 4447) and the reason behind their use (wellness, treatment or both) 10 . 41.3% of patients with migraine/severe headache stated they used CIM in the previous 12 months 10 . 29.6% used CIM for wellness only, 11.4% for treatment of migraine/severe headache and 59% for both wellness and treatment 10 . These data also show that only 31.3% of patients reported that a provider recommended CIM 9 and that fewer than 50% of adults with migraine/severe headaches discuss CIM use with their healthcare provider 9 To our knowledge, there are no publications using social media to investigate integrative methods used by migraine patients for treatment. Methods: Permission was obtained from The American Migraine Foundation (AMF), Yakkety Yak and the Yale University institutional review board to post our survey on social media. The AMF and Yakkety Yak, a digital marketing agency, launched the nationwide #MoveAgainstMigraine campaign in 2017 to mobilize and empower people living with migraine. This initiative led to the creation of the Move Against Migraine (MAM) Facebook group for migraine patients to advocate on behalf of themselves, to understand treatment options, to access resources to manage migraine symptoms, and to connect with leading doctors and researchers. At the time of this study, the group had approximately 18,000 members. Yakkety Yak posted our 17-question survey, created by the investigators, to the MAM Facebook community, for two months with reposting of the survey every 2 weeks between January 14,2019 – March 29,2019. The survey was voluntary, and no incentive was offered for completing it. The survey had not been used in previous studies and the questions were developed based on expert consensus from two University Headache centers. The target audience included patients who have used complementary and integrative medicine to treat and manage migraine. Consent was obtained from patients in order to participate in the survey. Anyone part of the (MAM) group was able to see the following post, and click on it if they wanted to participate: Are you a migraine patient over the age of 18 who is living with migraine and using integrative remedies not prescribed by your physician (acupuncture, Coenzyme Q, cannabinoids, massage therapy, etc.)? Dr. Deena Kuruvilla, a headache specialist from Yale School of Medicine, is conducting a survey on the use of integrative medicines/therapies for migraines, and we need your help. Please click here to participate. This study was submitted for review to the IRB and was granted an exemption. Consent was obtained from each member participating in the survey. When the participant clicked to participate in the survey, the first screen was a consent. They clicked a box in order to obtain their permission to complete the survey. While we specifically introduced our survey with migraine and integrative medicine in our social media link, we did have participants click on the link to confirm that they have not used integrative medicine. While Yakkety Yak posted the survey link on the group page, the survey itself was hosted on Qualtrics. Yakkety Yak did not have access to the collected data. Qualtrics provides tools that can be used to configure survey properties and to customize privacy settings, so respondents cannot be tracked to an IP or email address, name, ticket number, etc., which allows for anonymous responses. With these mechanisms as well as University firewall protected equipment, patient information was protected from unauthorized access. The data collected were used to better understand the integrative treatment methods used by migraine patients and to identify which methods are felt to be the most helpful. If any data were missing from participants, the participant survey was excluded using Qualtrics. Statistical Analysis For a 95% confidence level, we estimated a margin of error using 1/√ N , where N is the sample size. With our sample size of 335, we estimated a 5% margin of error. Based on this calculation, we believe our results are representative of a true population average. This analysis was descriptive in nature and therefore no formal hypothesis testing was conducted. Results: A total of 412 patients responded to the survey. Of the 412 patients, only 377 (91.5%) completed the survey in its entirety. 5 (.013%) patients were never diagnosed with migraine by a medical professional, leaving 372 (99%) clinically diagnosed with migraine. 335 out of the 372 (90%) answered yes to “Do you use Complementary and Integrative Medicine (CIM) approaches to treat migraine.” 37 9.9%) responded no to the above question. Of the patients who use CIM, 316 (94.3%) were female and 17 (5%) were male. Further demographics can be reviewed in Table 2 . 247 users (73.7%) met the International Classification of headache disorders, 3rd edition (ICHD-3) diagnosis of chronic migraine while 87 users (25.9%) met criteria for episodic migraine. Specific questions were asked in the survey to differentiate episodic migraine and chronic migraine. 291 (86.6%) patients used CIM in combination with mainstream migraine treatments. Regarding how patients are seeking guidance for their CIM treatments, 68 (20.2%) are being managed by a healthcare provider,24 (7.1%) patients utilize the internet, 12 (3.5%) seek help from a fellow person with migraine, 4 (1.1%) from a Naturopathic provider, and 193 (57.6%) from 2 or more of the above. Patients were asked which category of CIM (Meditation, relaxation, deep breathing exercises, guided imagery, yoga, cognitive behavioral therapy, biofeedback, mindfulness training, craniosacral therapy, or migraine specific supplements/vitamins) they use. 19 (5.6%) patients use meditation, relaxation, breathing exercises, and/or guided imagery. 9 (2.6%) selected cognitive behavioral therapy, 2 (.59%) patients use craniosacral therapy, 4 (1.19%) use mindfulness training, 2 (.59%) selected biofeedback, 9 patients (2.6%) selected yoga, 63 (18.8%) selected vitamins, 189 (56.4%) patients answered that they use two or more of the above, and 45 (13.4%) selected other. See Fig. 2 . 24 (5.9%) patients CIM treatments were very effective (50–100% reduction in headache days), 92 (22.6% selected moderately effective (10–50% reduction), 139 (34.1%) slightly effective (1–10% reduction in headache days), 76 (18.6%) selected not effective at all (no change in headache days) and 76 (18.6%) did not answer. With respect to nutraceutical use, 4 patients (1.19%) used Riboflavin, 78 (23.2%) use Magnesium, 4 (1.19%) selected Coenzyme q10, 1 (.298%) selected Butterbur, 15 (4.47%) selected other, 209 (62%) used a combination of 2 or more. 22 patients (6.56%) did not use any vitamin. See Fig. 1 . Of those who used vitamins, 12 (3.58%) patients felt the vitamins were very effective (50–100% reduction in headache days), 58 (17.3%) selected moderately effective (10–50% reduction), 132 (39.4%) slightly effective (1–10% reduction in headache days), 109 (32.5%) not effective at all (no change in headache days) and 24 (7.1%) did not answer. Although 10.7% of patients do not use any manipulation or body-based practices for migraine prevention, most (55.5%) use two or more therapies in combination. Of the individual therapies, participants reported using, massage therapy was most frequently used (12.5%), then chiropractic maneuvers (9.2%), next acupuncture (9.0%--note: round all numbers to the same decimal point). Craniosacral therapy was minimally used (1.2%) as well as “other” therapies (1.7%). See Fig. 3 . 27 (8.0%) patients answered that manipulation and/or body-based practices were very effective (50–100% reduction in headache days), 75 (22.3%) selected moderately effective (10–50% reduction), 114 (34%) patients selected slightly effective (1–10% reduction in headache days), 81 (24.1%) patients selected this CIM was not effective at all (no change in headache days) and 38 (11.3%) did not answer. Finally, the survey ended with two questions regarding cannabinoids and their perceived effectiveness in preventing migraine. 164 (48.9%) use cannabidiol oil (CBD) or other cannabis derivative to prevent migraine and 171 (51%) selected no to this question. 4 (2.4%) of the 164 patients found CBD or other cannabis derivatives extremely effective; 14 (8.5%) found these products very effective (50–100% reduction in headache days), 36 (21.9%) selected moderately effective (10–50% reduction); 43 (26.2%) found them slightly effective (1–10% reduction in headache days); 64 (39%) patients found CBD or other cannabis derivates not effective at all (no change in headache days). See Fig. 4 . Discussion: Our study is the first of its kind to identify social media as a vehicle to investigate common CIM approaches used by migraine patients for headache relief. There have however been other online survey studies. Lee et al. administered a 30-minute self-report survey on an online migraine headache resource (Migraine in America, www.migraine.com)t o investigate if CIM produced a negative life impact of headaches for chronic migraine patients 11 . They found that approximately half of the participants reported using three CIM treatments and yet, felt dissatisfied or indifferent to their treatment strategy They also found that migraine patients who use CIM were more likely to have more frequent migraine headaches. Only 20.2% of participants in our study seek guidance for their CIM strategies specifically by a healthcare provider (MD, DO, NP, PA), while over 50% of patients seek guidance using multiple other strategies such as research the internet, guidance from a fellow migraine sufferer, or guidance from a Naturopathic provider. It is crucial that physicians query patients about their use of herbs, supplements, and vitamins with their standard treatment, provide realistic expectations, and identify potential treatment adverse effects, drug-drug interactions and existing evidence base. Patients using butterbur for example, must be counseled to obtain pyrrolizidine-alkaloid-free formulations due to the potential for hepatotoxicity. Liver function must be closely monitored while using this supplement. In combination with the migraine vitamins, many patients used meditation, relaxation, deep breathing exercises, guided imagery, yoga, cognitive behavioral therapy, biofeedback, mindfulness training, and craniosacral therapy concurrently with the majority (56.4%) using 2 or more of these treatments. Of those, 76.7% of respondent patients found the combination moderately to very effective, This finding supports previous evidence that these strategies were being used in the general population 19 and in other select populations 19 – 22 due to and the combination of low-cost and ease of access. The evidence for using mind-body relaxation techniques recommended by the US Headache Consortium Guidelines 23 is based on the Agency for Health Care Policy and Research Technical Review, which found relaxation training (progressive muscle relaxation, autogenic training, meditation or passive relaxation), electromyography (EMG) biofeedback, and thermal biofeedback combined with relaxation training to have high quality (Grade A) evidence from well-performed research studies for the prevention of migraine 24 . From our study, 30.3% patients found patients perceived any manipulation or body-based practices such as acupuncture, chiropractic maneuvers, etc. alone provided moderately to very effective treatment. , 25 Finally, only 30.4% of respondent patients using cannabis as a treatment for moderate/severe migraine found it moderately to very effective. As early as third and fourth centuries BCE, Ayurvedic preparations used cannabis for “diseases of the head” like migraine 26 . It is postulated that cannabis shows potential to interrupt glutamate signaling leading to cortical spreading depression 27 , serotonin release from platelets 28 , cranial blood vessel dilation caused by NO and CGRP 29 . While some studies have shown a significant impact of cannabis treating migraine 30 and increased efficacy for medication overuse headache 31 , properly constructed placebo-controlled trials are required to determine efficacy and side effects. If patients and providers can have shared goals about integrative medicine use in migraine, they can have an open, non-judgmental dialogue about the risks and benefits of various approaches. The C.A.R.E mnemonic can be used when discussing CIM approaches with patients. Patients may have a specific perspective regarding treatment options based on their previous treatment experiences. It can be helpful to ask about their history with c onventional treatments while also a voiding judgement. When r eviewing integrative treatment options, it is imperative to counsel patients on their limitations so that they have appropriate expectations. Finally, in order to adequately educate patients on CIM, it is helpful to e xplore where the patient’s interest in CIM stems from. See table 1. Many patients use complementary integrative medicine because it fits in with their attitudes about health 32 ; addressing these beliefs, as well as potential benefits and complications, will improve patient-provider communication and more patient-centered care. Limitations: Selection bias is inherent in all social media – based studies. We were only able to capture data from those patients who are currently active in the Facebook group being polled. This limits the data applicability to the wider migraine audience, of which a small portion may be overrepresented in this group. Other biases may be introduced by unforeseen variables. We cannot regulate which users take part in the survey. The survey has questions designed to obtain information from patients who have a history or diagnosis of migraine; however, this cannot be confirmed. This is an unavoidable side effect of anonymous polling and may impact the reliability of the data. Although participants were advised to complete the survey once, the number of times the survey could have been completed by an individual was not regulated since the survey was anonymous through Qualtrics. The data presented in the text as well as the tables indicate “two or more therapies in combination”. We did not investigate which therapies were used in combinations. This survey had not been previously validated or applied previously in studies. The study is also limited by a small sample size, a disproportionately large percentage of Caucasian female participants, and a predominantly chronic migraine population which is not representative of the larger migraine population within the United States. Many chronic migraine patients turn to CIM because they have been refractory to mainstream treatments. For this reason, the data in this study regarding patient responsiveness to CIM treatments must be interpreted with caution as many of the survey respondents may have been refractory to mainstream treatments. The responses seen in this survey may not be generalizable to the average patient. Conclusions: This study provides an initial investigation into the demographic and practice patterns of patients who use CIM. While this sampling may not reflect CIM use across all individuals with migraine, it does strongly suggest the need for better education on the role of, and evidence for, CIM among headache care providers, and the need to ask patients specifically about their use of and interest in CIM. Abbreviations CIM = Complementary and Integrative Medicine NCCIH - National Center for Complementary and Integrative Health NCCAM = National Center for Complementary and Alternative medicine AMF = American Migraine Foundation MAM = “Move Against Migraine” campaign ICHD-3 = International Classification for Headache Disorders EMG = Electromyography C.A.R.E = C onventional treatment experience, A void judgement, R eview Integrative medicine options, E xplore complementary and Integrative medicine interest Declarations Ethical Approval and Consent to participate Ethical Approval and Consent to Participate was obtained from study participants and the study has been approved by relevant ethical committee and the whole research process complies with ethical guidelines Consent for Publication I, Deena Kuruvilla, give my consent for information about myself to be published in The Journal of Headache and Pain. I understand that the text and any pictures or videos published in the article will be freely available on the internet and may be seen by the general public. The pictures, videos and text may also appear on other websites or in print, may be translated into other languages or used for commercial purposes. I have been offered the opportunity to read the manuscript. Availability of supporting data The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing interests The authors of this study do not have any competing interest during the submission process. Funding No funding was received throughout the duration of this study Authors' contributions DK developed the theoretical formalism, and with the help of AM, performed the analytic calculations and performed the numerical simulations. Both AM and NR authors contributed to the final version of the manuscript. RC supervised the project. Acknowledgements I thank my colleagues at Yale University School of Medicine for their expertise and assistance throughout all aspects of our study. References Burch R, Loder S, Loder E, Smitherman T (2015) The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache 55:21–34. doi: 10.4322/acr.2017.018 Marmura MJ, Silberstein SD, Schwedt TJ (2015) The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies. Headache: The Journal of Head Face Pain 55(1):3–20. doi: 10.1111/head.12499 Gilmore B, Michael M (2011) Treatment of Acute Migraine Headache. Am Fam Physician 83(3):271–280 Weatherall MW (2015) The diagnosis and treatment of chronic migraine. Therapeutic Advances in Chronic Disease 6(3):115–123. doi: 10.1177/2040622315579627 Loder E, Rizzoli P (2018) Pharmacologic Prevention of Migraine: A Narrative Review of the State of the Art in 2018. Headache: The Journal of Head Face Pain. doi: 10.1111/head.13375 Complementary, Alternative, or Integrative Health: What's In a Name? (2018, October 04) Retrieved from https://nccih.nih.gov/health/integrative-health The Use and Cost of Complementary Health Approaches in the United States (2017, September 24) Retrieved from https://nccih.nih.gov/about/strategic-plans/2016/use-cost-complementary-health-approaches Rhee TG, Harris IM (2016) Gender Differences in the Use of Complementary and Alternative Medicine and Their Association With Moderate Mental Distress in U.S. Adults With Migraines/Severe Headaches. Headache: The Journal of Head Face Pain 57(1):97–108. doi: 10.1111/head.12986 Wells RE, Bertisch SM, Buettner C, Phillips RS, Mccarthy EP (2011) Complementary and Alternative Medicine Use Among Adults With Migraines/Severe Headaches. Headache: The Journal of Head Face Pain 51(7):1087–1097. doi: 10.1111/j.1526-4610.2011.01917.x Rhee TG, Harris IM (2018) Reasons for and perceived benefits of utilizing complementary and alternative medicine in U.S. adults with migraines/severe headaches. Complementary Therapies in Clinical Practice 30:44–49. doi: 10.1016/j.ctcp.2017.12.003 Lee J, Bhowmick A, Wachholtz A (2016) Does complementary and alternative medicine (CAM) use reduce negative life impact of headaches for chronic migraineurs? A national survey. SpringerPlus, 5(1). doi: 10.1186/s40064-016-2362-7 Linnman C, Maleki N, Becerra L, Borsook D (2012) Migraine Tweets – What can online behavior tell us about disease? Cephalalgia 33(1):68–69. doi: 10.1177/0333102412465207 Kristoffersen AE, Stub T, Salamonsen A, Musial F, Hamberg K (2014) Gender differences in prevalence and associations for use of CAM in a large population study. BMC Complement Alternat Med 14:463 Vaidya V, Partha G, Karmakar M (2012) Gender differences in utilization of preventive care services in the United States. J Womens Health (Larchmt) 21:140–145 Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA (2000) Gender differences in the utilization of health care services. J Fam Pract 49:147–152 Manteuffel M, Williams S, Chen W, Verbrugge RR, Pittman DG, Steinkellner A (2014) Influence of patient sex and gender on medication use, adherence, and prescribing alignment with guidelines. J Womens Health (Larchmt) 23:112–119 Bonetto N, Santelli L, Battistin L, Cagnin A (2007) Serotonin syndrome and rhabdomyolysis induced by concomitant use of triptans, fluoxetine and hypericum. Cephalalgia 27:1421–1423 EvansRW,TepperSJ,ShapiroRE,Sun-EdelsteinC, Tietjen GE. The FDA alert on serotonin syndrome with use of triptans combined with selective serotonin reuptake inhibitors or selective serotonin norepinephrine reuptake inhibitors: American Headache Society position paper. Headache. 2010; 50:1089–1099 Barnes PM, Bloom B, Nahin RL (2008) Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Rep 12:1–23 Wells RE (2010) Phillips RS,Schachter SC,McCarthy EP. Complementary and alternative medicine use among US adults with common neurological conditions. J Neurol 257:1822–1831 Yeh GY (2006) Davis RB,Phillips RS.Use of complementary therapies in patients with cardiovascular disease. Am J Cardiol 98:673–680 Bertisch SM, Wee CC, McCarthy EP (2008) Use of complementary and alternative therapies by overweight and obese adults. Obesity (Silver Spring) 16:1610–1615 Campbell JK, Penzien DB, Wall EM. Evidencebased guidelines for migraine headache: behavioral and physical treatments. US Headache Consortium 2000.2000.[Accessed July 14,2009].Available from http://www.aan.com Goslin RE, Gray RN, McCrory DC, Penzien D, Rains J, Hasselblad V (1999) Behavioral and Physical Treatments for Migraine Headache. Research AfHCPa, Rockville Rhee TG, Harris IM (2017) Gender Differences in the Use of Complementary and Alternative Medicine and Their Association With Moderate Mental Distress in U.S. Adults With Migraines/Severe Headaches. Headache: The Journal of Head Face Pain 57:97–108. doi: 10.1111/head.12986 Gunther R, Goodyer J (1968) The Greek herbal of Dioscorides: illustrated by a Byzantine, AD 512. Hafner Publishing Company, New York Juhasz G, Lazary J, Chase D et al (2009) Variations in the cannabinoid receptor 1 gene predispose to migraine. Neurosci Lett 461:116–120 Cupini LM, Costa C, Sarchielli P et al (2008) Degradation of endocannabinoids in chronic migraine and medication overuse headache. Neurobiol Dis 30:186–189 Osborn LA, Lauritsen KJ, Cross N et al (2015) Self-Medication of Somatic and Psychiatric Conditions Using Botanical Marijuana. J Psychoactive Drugs 47:345–335 Robbins MS, Tarshish S, Solomon S et al (2009) Cluster attacks responsive to recreational cannabis and dronabinol. Headache 49:914–916 Astin JA (1998) Why patients use alternative medicine: Results of a national study. JAMA 279:15481553 Table Table 1 Demographics for CIM users (N = 335) Male 17 18–24 years old 20 White 296 Female 316 25–34 years old 46 Hispanic or Latino 12 Prefer not to answer 1 35–44 years old 80 American Indian or Alaska Native 4 No Answer 1 45–54 years old 78 Asian 8 55–64 years old 82 Native Hawaiian or Pacific Islander 0 65 years old or over 29 Other 10 Prefer not to answer 5 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-25263","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":526968,"identity":"75a4ad45-299e-4be8-934a-6a53ef19313e","order_by":1,"name":"Deena E Kuruvilla","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIiWNgGAWjYDCCA2AyAcJ+UMAgx8DA3ABkMxOpJcGAwZiBgZEELQxALYkNhLTwHW8+9uAHQ1ri9hk5hkBb7NI3HD/Y+IChwjqxAYcWyTPH0g17GHIS59zIMQBqSc7dcCax2YDhTDpOLQY3cswkeBgqEmdIpCUAtTDnbjiQ2CbB2HYYt5b7779J/kFoqU83OP+w/QfjPzxabvCwSfMAHTZDIvkAUMvhBIMbiW3AEMCtRfJMmpm0jEGa8QyexyAtxw1n3njYLJFwLN0Ylxa+44efSb6pSJadwZ7Y/OFDRbU83/nkgx8+1FjL4tICdR4SW+EAAzyeiATy+E0fBaNgFIyCEQgA6PhkLFDbeGEAAAAASUVORK5CYII=","orcid":"","institution":"","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Deena","middleName":"E","lastName":"Kuruvilla","suffix":""},{"id":526969,"identity":"65efee69-3988-4e90-ad22-6bf43a789cb8","order_by":2,"name":"Amit Mehta","email":"","orcid":"","institution":"Yale University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Amit","middleName":"","lastName":"Mehta","suffix":""},{"id":526970,"identity":"e6896c9e-2640-49f9-bd86-5f84dd42e0f6","order_by":3,"name":"Nidhi Ravishankar","email":"","orcid":"","institution":"Yale University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nidhi","middleName":"","lastName":"Ravishankar","suffix":""},{"id":526971,"identity":"0b001129-fd77-4e3a-b496-e21977171a88","order_by":4,"name":"Robert Cowan","email":"","orcid":"","institution":"Stanford University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Robert","middleName":"","lastName":"Cowan","suffix":""}],"badges":[],"createdAt":"2020-04-24 11:28:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-25263/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-25263/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":1028169,"identity":"6c12a963-7296-4cb9-94d1-655388dfe5ba","added_by":"auto","created_at":"2020-05-04 19:22:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26326,"visible":true,"origin":"","legend":"Percent of Participants Using Natural Products","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-25263/v1/fig1.png"},{"id":1028170,"identity":"adaef74d-f802-4853-bd6c-03b7191dfede","added_by":"auto","created_at":"2020-05-04 19:22:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":28050,"visible":true,"origin":"","legend":"Percent of Participants Using Mind-Body Medicine","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-25263/v1/fig2.png"},{"id":1028171,"identity":"bbc5c5b5-f445-404b-8f98-bc48a00500fe","added_by":"auto","created_at":"2020-05-04 19:22:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":29700,"visible":true,"origin":"","legend":"Percent of Patients Using Manipulative and Body-Based Practices","description":"","filename":"fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-25263/v1/fig3.png"},{"id":1028172,"identity":"30f0d477-abe0-4b72-93cd-4d1bdab296ac","added_by":"auto","created_at":"2020-05-04 19:22:29","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":33480,"visible":true,"origin":"","legend":"Percent of Patients with Degree of Effectiveness of Cannabinoid or Cannabis Derivatives Use","description":"","filename":"fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-25263/v1/fig4.png"},{"id":13501684,"identity":"57ae38d3-e08e-4fec-a029-f5c71adec155","added_by":"auto","created_at":"2021-09-16 23:11:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":315446,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-25263/v1/dfa6e035-ee0d-48a9-a73e-c66775311574.pdf"}],"financialInterests":"","formattedTitle":"A Patient perspective of Complementary and Integrative Medicine (CIM) for Migraine Treatment: A social media survey","fulltext":[{"header":"Introduction:","content":" \u003cp\u003eMigraine affects 1 out of every 7 Americans annually and is 2 to 3 times more common in females than males\u003csup\u003e \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e \u003c/sup\u003e. The financial burden of migraine in the United States is estimated to be \u003cspan\u003e$\u003c/span\u003e1,533 per patient annually for episodic migraine and \u003cspan\u003e$\u003c/span\u003e4,144 for those with chronic migraine. Costs are higher in vulnerable or underserved populations, such as those who have low socioeconomic status, the uninsured, and the unemployed\u003csup\u003e \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e \u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWhile new migraine preventive and abortive treatments emerging, research shows that a significant percentage of our patients are looking beyond standard medical treatments and incorporating complementary and integrative medicine (CIM). According to epidemiological studies, 28\u0026ndash;82% of people with headache use CIM approaches\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, while 50% of people with headache do not discuss their CIM treatments with their healthcare provider\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCIM is defined by the National Center for Complementary and Integrative Health (NCCIH) as treatments that are separate from mainstream medicine but may be integrated with it\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. NCCIH was previously called the National Center for Complementary and Alternative medicine (NCCAM) but was changed to NCCIH based on the escalation in use of complementary approaches by Americans. NCCIH more accurately reflects that Americans are no longer using these approaches \u0026ldquo;alternatively\u0026rdquo; but rather in conjunction with mainstream medicine. \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003eExamples of CIM are commonly divided into two main categories: Natural products (herbs, vitamins, minerals and probiotics) and mind-body practices (yoga, chiropractic, meditation and massage therapy)\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Each category is further divided into a subcategory of CIM with meditation/yoga, herbal therapies, massage/chiropractic, and acupuncture being the top CIM in each category, respectively.\u003c/p\u003e \u003cp\u003eIn 2012, the National Health Interview Survey reported on 88,962 American adults and 17,321 children and found 33.2% of adults and 11.6% of children used CIM in the previous 12 months\u003csup\u003e \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e \u003c/sup\u003e. Additionally, Americans spent \u003cspan\u003e$\u003c/span\u003e30.2\u0026nbsp;billion on complementary health approaches during the same period\u003csup\u003e \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e \u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEducated women with migraine are more likely to use CIM\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Wells et al., using the 2007 National Health Interview Survey (n\u0026thinsp;=\u0026thinsp;23,393) compared CIM use between adults with and without migraine/severe headache\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. 49.5% of patients with migraine/severe headache used at least 1 Integrative treatment in the previous 12 months compared to 33.9% of patients without migraine/severe headache. Researchers noted that adults with migraine/severe headache used CIM more often for treatment because: their provider recommended it, mainstream treatment was ineffective, or mainstream and/or mainstream treatment was too expensive \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSimilarly, Rhee et al. used the 2012 National Health Interview Survey to estimate the prevalence rates of CIM use in adults with migraine/severe headache (n\u0026thinsp;=\u0026thinsp;4447) and the reason behind their use (wellness, treatment or both) \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. 41.3% of patients with migraine/severe headache stated they used CIM in the previous 12 months\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. 29.6% used CIM for wellness only, 11.4% for treatment of migraine/severe headache and 59% for both wellness and treatment\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. These data also show that only 31.3% of patients reported that a provider recommended CIM\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e and that fewer than 50% of adults with migraine/severe headaches discuss CIM use with their healthcare provider\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTo our knowledge, there are no publications using social media to investigate integrative methods used by migraine patients for treatment.\u003c/p\u003e "},{"header":"Methods:","content":" \u003cp\u003ePermission was obtained from The American Migraine Foundation (AMF), Yakkety Yak and the Yale University institutional review board to post our survey on social media. The AMF and Yakkety Yak, a digital marketing agency, launched the nationwide #MoveAgainstMigraine campaign in 2017 to mobilize and empower people living with migraine. This initiative led to the creation of the Move Against Migraine (MAM) Facebook group for migraine patients to advocate on behalf of themselves, to understand treatment options, to access resources to manage migraine symptoms, and to connect with leading doctors and researchers. At the time of this study, the group had approximately 18,000 members.\u003c/p\u003e \u003cp\u003eYakkety Yak posted our 17-question survey, created by the investigators, to the MAM Facebook community, for two months with reposting of the survey every 2 weeks between January 14,2019 \u0026ndash; March 29,2019. The survey was voluntary, and no incentive was offered for completing it. The survey had not been used in previous studies and the questions were developed based on expert consensus from two University Headache centers. The target audience included patients who have used complementary and integrative medicine to treat and manage migraine. Consent was obtained from patients in order to participate in the survey. Anyone part of the (MAM) group was able to see the following post, and click on it if they wanted to participate:\u003cdiv class=\"BlockQuote\"\u003e\u003cdiv id=\"Par18\" class=\"Para\"\u003eAre you a migraine patient over the age of 18 who is living with migraine and using integrative remedies not prescribed by your physician (acupuncture, Coenzyme Q, cannabinoids, massage therapy, etc.)? Dr. Deena Kuruvilla, a headache specialist from Yale School of Medicine, is conducting a survey on the use of integrative medicines/therapies for migraines, and we need your help. Please click here to participate.\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis study was submitted for review to the IRB and was granted an exemption. Consent was obtained from each member participating in the survey. When the participant clicked to participate in the survey, the first screen was a consent. They clicked a box in order to obtain their permission to complete the survey. While we specifically introduced our survey with migraine and integrative medicine in our social media link, we did have participants click on the link to confirm that they have not used integrative medicine. While Yakkety Yak posted the survey link on the group page, the survey itself was hosted on Qualtrics. Yakkety Yak did not have access to the collected data. Qualtrics provides tools that can be used to configure survey properties and to customize privacy settings, so respondents cannot be tracked to an IP or email address, name, ticket number, etc., which allows for anonymous responses. With these mechanisms as well as University firewall protected equipment, patient information was protected from unauthorized access. The data collected were used to better understand the integrative treatment methods used by migraine patients and to identify which methods are felt to be the most helpful. If any data were missing from participants, the participant survey was excluded using Qualtrics.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eFor a 95% confidence level, we estimated a margin of error using 1/\u0026radic;\u003cem\u003eN\u003c/em\u003e, where \u003cem\u003eN\u003c/em\u003e is the sample size. With our sample size of 335, we estimated a 5% margin of error. Based on this calculation, we believe our results are representative of a true population average. This analysis was descriptive in nature and therefore no formal hypothesis testing was conducted.\u003c/p\u003e \u003c/div\u003e "},{"header":"Results:","content":" \u003cp\u003eA total of 412 patients responded to the survey. Of the 412 patients, only 377 (91.5%) completed the survey in its entirety. 5 (.013%) patients were never diagnosed with migraine by a medical professional, leaving 372 (99%) clinically diagnosed with migraine. 335 out of the 372 (90%) answered yes to \u0026ldquo;Do you use Complementary and Integrative Medicine (CIM) approaches to treat migraine.\u0026rdquo; 37 9.9%) responded no to the above question. Of the patients who use CIM, 316 (94.3%) were female and 17 (5%) were male. Further demographics can be reviewed in \u003cb\u003eTable\u0026nbsp;2\u003c/b\u003e. 247 users (73.7%) met the International Classification of headache disorders, 3rd edition (ICHD-3) diagnosis of chronic migraine while 87 users (25.9%) met criteria for episodic migraine. Specific questions were asked in the survey to differentiate episodic migraine and chronic migraine. 291 (86.6%) patients used CIM in combination with mainstream migraine treatments. Regarding how patients are seeking guidance for their CIM treatments, 68 (20.2%) are being managed by a healthcare provider,24 (7.1%) patients utilize the internet, 12 (3.5%) seek help from a fellow person with migraine, 4 (1.1%) from a Naturopathic provider, and 193 (57.6%) from 2 or more of the above.\u003c/p\u003e \u003cp\u003ePatients were asked which category of CIM (Meditation, relaxation, deep breathing exercises, guided imagery, yoga, cognitive behavioral therapy, biofeedback, mindfulness training, craniosacral therapy, or migraine specific supplements/vitamins) they use. 19 (5.6%) patients use meditation, relaxation, breathing exercises, and/or guided imagery. 9 (2.6%) selected cognitive behavioral therapy, 2 (.59%) patients use craniosacral therapy, 4 (1.19%) use mindfulness training, 2 (.59%) selected biofeedback, 9 patients (2.6%) selected yoga, 63 (18.8%) selected vitamins, 189 (56.4%) patients answered that they use two or more of the above, and 45 (13.4%) selected other. \u003cb\u003eSee Fig.\u0026nbsp;2\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e24 (5.9%) patients CIM treatments were very effective (50\u0026ndash;100% reduction in headache days), 92 (22.6% selected moderately effective (10\u0026ndash;50% reduction), 139 (34.1%) slightly effective (1\u0026ndash;10% reduction in headache days), 76 (18.6%) selected not effective at all (no change in headache days) and 76 (18.6%) did not answer.\u003c/p\u003e \u003cp\u003eWith respect to nutraceutical use, 4 patients (1.19%) used Riboflavin, 78 (23.2%) use Magnesium, 4 (1.19%) selected Coenzyme q10, 1 (.298%) selected Butterbur, 15 (4.47%) selected other, 209 (62%) used a combination of 2 or more. 22 patients (6.56%) did not use any vitamin. \u003cb\u003eSee Fig.\u0026nbsp;1\u003c/b\u003e. Of those who used vitamins, 12 (3.58%) patients felt the vitamins were very effective (50\u0026ndash;100% reduction in headache days), 58 (17.3%) selected moderately effective (10\u0026ndash;50% reduction), 132 (39.4%) slightly effective (1\u0026ndash;10% reduction in headache days), 109 (32.5%) not effective at all (no change in headache days) and 24 (7.1%) did not answer.\u003c/p\u003e \u003cp\u003eAlthough 10.7% of patients do not use any manipulation or body-based practices for migraine prevention, most (55.5%) use two or more therapies in combination. Of the individual therapies, participants reported using, massage therapy was most frequently used (12.5%), then chiropractic maneuvers (9.2%), next acupuncture (9.0%--note: round all numbers to the same decimal point). Craniosacral therapy was minimally used (1.2%) as well as \u0026ldquo;other\u0026rdquo; therapies (1.7%). \u003cb\u003eSee Fig.\u0026nbsp;3\u003c/b\u003e. 27 (8.0%) patients answered that manipulation and/or body-based practices were very effective (50\u0026ndash;100% reduction in headache days), 75 (22.3%) selected moderately effective (10\u0026ndash;50% reduction), 114 (34%) patients selected slightly effective (1\u0026ndash;10% reduction in headache days), 81 (24.1%) patients selected this CIM was not effective at all (no change in headache days) and 38 (11.3%) did not answer.\u003c/p\u003e \u003cp\u003eFinally, the survey ended with two questions regarding cannabinoids and their perceived effectiveness in preventing migraine. 164 (48.9%) use cannabidiol oil (CBD) or other cannabis derivative to prevent migraine and 171 (51%) selected no to this question. 4 (2.4%) of the 164 patients found CBD or other cannabis derivatives extremely effective; 14 (8.5%) found these products very effective (50\u0026ndash;100% reduction in headache days), 36 (21.9%) selected moderately effective (10\u0026ndash;50% reduction); 43 (26.2%) found them slightly effective (1\u0026ndash;10% reduction in headache days); 64 (39%) patients found CBD or other cannabis derivates not effective at all (no change in headache days). \u003cb\u003eSee Fig.\u0026nbsp;4\u003c/b\u003e.\u003c/p\u003e "},{"header":"Discussion:","content":" \u003cp\u003eOur study is the first of its kind to identify social media as a vehicle to investigate common CIM approaches used by migraine patients for headache relief. There have however been other online survey studies. Lee et al. administered a 30-minute self-report survey on an online migraine headache resource (Migraine in America, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.migraine.com)t\" target=\"_blank\"\u003ewww.migraine.com)t\u003c/a\u003e\u003c/span\u003e\u003c/span\u003eo investigate if CIM produced a negative life impact of headaches for chronic migraine patients \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. They found that approximately half of the participants reported using three CIM treatments and yet, felt dissatisfied or indifferent to their treatment strategy They also found that migraine patients who use CIM were more likely to have more frequent migraine headaches.\u003c/p\u003e \u003cp\u003eOnly 20.2% of participants in our study seek guidance for their CIM strategies specifically by a healthcare provider (MD, DO, NP, PA), while over 50% of patients seek guidance using multiple other strategies such as research the internet, guidance from a fellow migraine sufferer, or guidance from a Naturopathic provider. It is crucial that physicians query patients about their use of herbs, supplements, and vitamins with their standard treatment, provide realistic expectations, and identify potential treatment adverse effects, drug-drug interactions and existing evidence base. Patients using butterbur for example, must be counseled to obtain pyrrolizidine-alkaloid-free formulations due to the potential for hepatotoxicity. Liver function must be closely monitored while using this supplement.\u003c/p\u003e \u003cp\u003eIn combination with the migraine vitamins, many patients used meditation, relaxation, deep breathing exercises, guided imagery, yoga, cognitive behavioral therapy, biofeedback, mindfulness training, and craniosacral therapy concurrently with the majority (56.4%) using 2 or more of these treatments. Of those, 76.7% of respondent patients found the combination moderately to very effective, This finding supports previous evidence that these strategies were being used in the general population\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e and in other select populations\u003csup\u003e\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003edue to and the combination of low-cost and ease of access.\u003c/p\u003e \u003cp\u003eThe evidence for using mind-body relaxation techniques recommended by the US Headache Consortium Guidelines\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e is based on the Agency for Health Care Policy and Research Technical Review, which found relaxation training (progressive muscle relaxation, autogenic training, meditation or passive relaxation), electromyography (EMG) biofeedback, and thermal biofeedback combined with relaxation training to have high quality (Grade A) evidence from well-performed research studies for the prevention of migraine\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFrom our study, 30.3% patients found patients perceived any manipulation or body-based practices such as acupuncture, chiropractic maneuvers, etc. alone provided moderately to very effective treatment.\u003csup\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFinally, only 30.4% of respondent patients using cannabis as a treatment for moderate/severe migraine found it moderately to very effective. As early as third and fourth centuries BCE, Ayurvedic preparations used cannabis for \u0026ldquo;diseases of the head\u0026rdquo; like migraine\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. It is postulated that cannabis shows potential to interrupt glutamate signaling leading to cortical spreading depression\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e, serotonin release from platelets\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e, cranial blood vessel dilation caused by NO and CGRP\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. While some studies have shown a significant impact of cannabis treating migraine\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e and increased efficacy for medication overuse headache \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e, properly constructed placebo-controlled trials are required to determine efficacy and side effects.\u003c/p\u003e \u003cp\u003eIf patients and providers can have shared goals about integrative medicine use in migraine, they can have an open, non-judgmental dialogue about the risks and benefits of various approaches. The C.A.R.E mnemonic can be used when discussing CIM approaches with patients. Patients may have a specific perspective regarding treatment options based on their previous treatment experiences. It can be helpful to ask about their history with \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003ec\u003c/span\u003eonventional treatments while also \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003ea\u003c/span\u003evoiding judgement. When \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003er\u003c/span\u003eeviewing integrative treatment options, it is imperative to counsel patients on their limitations so that they have appropriate expectations. Finally, in order to adequately educate patients on CIM, it is helpful to \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003ee\u003c/span\u003explore where the patient\u0026rsquo;s interest in CIM stems from. See table 1.\u003c/p\u003e \u003cp\u003eMany patients use complementary integrative medicine because it fits in with their attitudes about health\u003csup\u003e32\u003c/sup\u003e; addressing these beliefs, as well as potential benefits and complications, will improve patient-provider communication and more patient-centered care.\u003c/p\u003e "},{"header":"Limitations:","content":" \u003cp\u003eSelection bias is inherent in all social media \u0026ndash; based studies. We were only able to capture data from those patients who are currently active in the Facebook group being polled. This limits the data applicability to the wider migraine audience, of which a small portion may be overrepresented in this group. Other biases may be introduced by unforeseen variables.\u003c/p\u003e \u003cp\u003eWe cannot regulate which users take part in the survey. The survey has questions designed to obtain information from patients who have a history or diagnosis of migraine; however, this cannot be confirmed. This is an unavoidable side effect of anonymous polling and may impact the reliability of the data. Although participants were advised to complete the survey once, the number of times the survey could have been completed by an individual was not regulated since the survey was anonymous through Qualtrics. The data presented in the text as well as the tables indicate \u0026ldquo;two or more therapies in combination\u0026rdquo;. We did not investigate which therapies were used in combinations.\u003c/p\u003e \u003cp\u003eThis survey had not been previously validated or applied previously in studies. The study is also limited by a small sample size, a disproportionately large percentage of Caucasian female participants, and a predominantly chronic migraine population which is not representative of the larger migraine population within the United States. Many chronic migraine patients turn to CIM because they have been refractory to mainstream treatments. For this reason, the data in this study regarding patient responsiveness to CIM treatments must be interpreted with caution as many of the survey respondents may have been refractory to mainstream treatments. The responses seen in this survey may not be generalizable to the average patient.\u003c/p\u003e "},{"header":"Conclusions:","content":"\u003cp\u003eThis study provides an initial investigation into the demographic and practice patterns of patients who use CIM. While this sampling may not reflect CIM use across all individuals with migraine, it does strongly suggest the need for better education on the role of, and evidence for, CIM among headache care providers, and the need to ask patients specifically about their use of and interest in CIM.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eCIM = Complementary and Integrative Medicine\u003c/p\u003e\n\u003cp\u003eNCCIH - National Center for Complementary and Integrative Health\u003c/p\u003e\n\u003cp\u003eNCCAM = National Center for Complementary and Alternative medicine\u003c/p\u003e\n\u003cp\u003eAMF = American Migraine Foundation\u003c/p\u003e\n\u003cp\u003eMAM = \u0026ldquo;Move Against Migraine\u0026rdquo; campaign\u003c/p\u003e\n\u003cp\u003eICHD-3 = International Classification for Headache Disorders\u003c/p\u003e\n\u003cp\u003eEMG = Electromyography\u003c/p\u003e\n\u003cp\u003eC.A.R.E = \u003cstrong\u003e\u003cu\u003eC\u003c/u\u003e\u003c/strong\u003eonventional treatment experience, \u003cstrong\u003e\u003cu\u003eA\u003c/u\u003e\u003c/strong\u003evoid judgement, \u003cstrong\u003e\u003cu\u003eR\u003c/u\u003e\u003c/strong\u003eeview Integrative medicine options, \u003cstrong\u003e\u003cu\u003eE\u003c/u\u003e\u003c/strong\u003explore complementary and Integrative medicine interest\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthical Approval and Consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthical Approval and Consent to Participate was obtained from study participants and the study\u003c/em\u003e has been approved by relevant\u0026nbsp;\u003cem\u003eethical\u003c/em\u003e\u0026nbsp;committee and the whole research process complies with\u0026nbsp;\u003cem\u003eethical\u003c/em\u003e\u0026nbsp;guidelines\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for Publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eI, Deena Kuruvilla, give my consent for information about myself to be published in The Journal of Headache and Pain. I understand that the text and any pictures or videos published in the article will be freely available on the internet and may be seen by the general public. The pictures, videos and text may also appear on other websites or in print, may be translated into other languages or used for commercial purposes. I have been offered the opportunity to read the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of supporting data\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors of this study do not have any competing interest during the submission process.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received throughout the duration of this study\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDK developed the theoretical formalism, and with the help of AM, performed the analytic calculations and performed the numerical simulations. Both AM and NR authors contributed to the final version of the manuscript. RC supervised the project.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eI thank my colleagues at Yale University School of Medicine for their expertise and assistance throughout all aspects of our study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e \u003cspan\u003eBurch R, Loder S, Loder E, Smitherman T (2015) The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache 55:21\u0026ndash;34. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4322/acr.2017.018\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eMarmura MJ, Silberstein SD, Schwedt TJ (2015) The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies. Headache: The Journal of Head Face Pain 55(1):3\u0026ndash;20. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/head.12499\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eGilmore B, Michael M (2011) Treatment of Acute Migraine Headache. Am Fam Physician 83(3):271\u0026ndash;280\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eWeatherall MW (2015) The diagnosis and treatment of chronic migraine. Therapeutic Advances in Chronic Disease 6(3):115\u0026ndash;123. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2040622315579627\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eLoder E, Rizzoli P (2018) Pharmacologic Prevention of Migraine: A Narrative Review of the State of the Art in 2018. Headache: The Journal of Head Face Pain. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/head.13375\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eComplementary, Alternative, or Integrative Health: What's In a Name? (2018, October 04) Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://nccih.nih.gov/health/integrative-health\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eThe Use and Cost of Complementary Health Approaches in the United States (2017, September 24) Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://nccih.nih.gov/about/strategic-plans/2016/use-cost-complementary-health-approaches\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eRhee TG, Harris IM (2016) Gender Differences in the Use of Complementary and Alternative Medicine and Their Association With Moderate Mental Distress in U.S. Adults With Migraines/Severe Headaches. Headache: The Journal of Head Face Pain 57(1):97\u0026ndash;108. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/head.12986\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eWells RE, Bertisch SM, Buettner C, Phillips RS, Mccarthy EP (2011) Complementary and Alternative Medicine Use Among Adults With Migraines/Severe Headaches. Headache: The Journal of Head Face Pain 51(7):1087\u0026ndash;1097. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1526-4610.2011.01917.x\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eRhee TG, Harris IM (2018) Reasons for and perceived benefits of utilizing complementary and alternative medicine in U.S. adults with migraines/severe headaches. Complementary Therapies in Clinical Practice 30:44\u0026ndash;49. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ctcp.2017.12.003\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eLee J, Bhowmick A, Wachholtz A (2016) Does complementary and alternative medicine (CAM) use reduce negative life impact of headaches for chronic migraineurs? A national survey. SpringerPlus, 5(1). doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40064-016-2362-7\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eLinnman C, Maleki N, Becerra L, Borsook D (2012) Migraine Tweets \u0026ndash; What can online behavior tell us about disease? Cephalalgia 33(1):68\u0026ndash;69. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0333102412465207\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eKristoffersen AE, Stub T, Salamonsen A, Musial F, Hamberg K (2014) Gender differences in prevalence and associations for use of CAM in a large population study. BMC Complement Alternat Med 14:463\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eVaidya V, Partha G, Karmakar M (2012) Gender differences in utilization of preventive care services in the United States. J Womens Health (Larchmt) 21:140\u0026ndash;145\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eBertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA (2000) Gender differences in the utilization of health care services. J Fam Pract 49:147\u0026ndash;152\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eManteuffel M, Williams S, Chen W, Verbrugge RR, Pittman DG, Steinkellner A (2014) Influence of patient sex and gender on medication use, adherence, and prescribing alignment with guidelines. J Womens Health (Larchmt) 23:112\u0026ndash;119\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eBonetto N, Santelli L, Battistin L, Cagnin A (2007) Serotonin syndrome and rhabdomyolysis induced by concomitant use of triptans, fluoxetine and hypericum. Cephalalgia 27:1421\u0026ndash;1423\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eEvansRW,TepperSJ,ShapiroRE,Sun-EdelsteinC, Tietjen GE. The FDA alert on serotonin syndrome with use of triptans combined with selective serotonin reuptake inhibitors or selective serotonin norepinephrine reuptake inhibitors: American Headache Society position paper. Headache. 2010; 50:1089\u0026ndash;1099\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eBarnes PM, Bloom B, Nahin RL (2008) Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Rep 12:1\u0026ndash;23\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eWells RE (2010) Phillips RS,Schachter SC,McCarthy EP. Complementary and alternative medicine use among US adults with common neurological conditions. J Neurol 257:1822\u0026ndash;1831\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eYeh GY (2006) Davis RB,Phillips RS.Use of complementary therapies in patients with cardiovascular disease. Am J Cardiol 98:673\u0026ndash;680\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eBertisch SM, Wee CC, McCarthy EP (2008) Use of complementary and alternative therapies by overweight and obese adults. Obesity (Silver Spring) 16:1610\u0026ndash;1615\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eCampbell JK, Penzien DB, Wall EM. Evidencebased guidelines for migraine headache: behavioral and physical treatments. US Headache Consortium 2000.2000.[Accessed July 14,2009].Available from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.aan.com\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eGoslin RE, Gray RN, McCrory DC, Penzien D, Rains J, Hasselblad V (1999) Behavioral and Physical Treatments for Migraine Headache. Research AfHCPa, Rockville\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eRhee TG, Harris IM (2017) Gender Differences in the Use of Complementary and Alternative Medicine and Their Association With Moderate Mental Distress in U.S. Adults With Migraines/Severe Headaches. Headache: The Journal of Head Face Pain 57:97\u0026ndash;108. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/head.12986\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eGunther R, Goodyer J (1968) The Greek herbal of Dioscorides: illustrated by a Byzantine, AD 512. Hafner Publishing Company, New York\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eJuhasz G, Lazary J, Chase D et al (2009) Variations in the cannabinoid receptor 1 gene predispose to migraine. Neurosci Lett 461:116\u0026ndash;120\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eCupini LM, Costa C, Sarchielli P et al (2008) Degradation of endocannabinoids in chronic migraine and medication overuse headache. Neurobiol Dis 30:186\u0026ndash;189\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eOsborn LA, Lauritsen KJ, Cross N et al (2015) Self-Medication of Somatic and Psychiatric Conditions Using Botanical Marijuana. J Psychoactive Drugs 47:345\u0026ndash;335\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eRobbins MS, Tarshish S, Solomon S et al (2009) Cluster attacks responsive to recreational cannabis and dronabinol. Headache 49:914\u0026ndash;916\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eAstin JA (1998) Why patients use alternative medicine: Results of a national study. JAMA 279:15481553\u003c/span\u003e \u003c/li\u003e\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 1\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDemographics for CIM users (N\u0026thinsp;=\u0026thinsp;335)\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMale\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e17\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e18\u0026ndash;24\u0026nbsp;years old\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e20\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eWhite\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e296\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eFemale\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e316\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e25\u0026ndash;34\u0026nbsp;years old\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e46\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHispanic or Latino\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e12\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePrefer not to answer\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e1\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e35\u0026ndash;44\u0026nbsp;years old\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e80\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAmerican Indian or Alaska Native\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e4\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eNo Answer\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e1\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e45\u0026ndash;54\u0026nbsp;years old\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e78\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAsian\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e8\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e55\u0026ndash;64\u0026nbsp;years old\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e82\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eNative Hawaiian or Pacific Islander\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e65\u0026nbsp;years old or over\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e29\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eOther\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e10\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePrefer not to answer\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e5\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Integrative medicine, alternative medicine, headache, migraine, social media survey","lastPublishedDoi":"10.21203/rs.3.rs-25263/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-25263/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOBJECTIVE: To survey persons with migraine who use social media about Complementary and Integrative Medicine (CIM) for the treatment of migraine.\u003c/p\u003e\u003cp\u003eBACKGROUND: CIM encompasses medical treatments that are not part of ,but are used in concert with, mainstream medicine. Between 28–82% of people with migraine use non-drug approaches, and approximately 50% of people with migraine do not discuss non-drug treatments with their healthcare providers (HCPs) \u003csup\u003e9\u003c/sup\u003e. it is important for providers to be conversant with CIM treatments and the available evidence-based data. To further this effort, the Complementary and Integrative Medicine Special Interest Section (CIMSIS) of the American Headache Society surveyed migraine patients directly through social media to identify CIM practices in which they engage.\u003c/p\u003e\u003cp\u003eMETHODS: In collaboration with the American Migraine foundation (AMF) and Yakkety Yak, a digital marketing agency, we posted a 17-question survey on the Move Against Migraine (MAM) Facebook group, which has 20,000 + members. The goals of the survey were to assess the attitudes toward CIM among this group, to identify which CIM modalities are being used and to determine what patients considered to be the most effective CIM modalities. While Yakkety Yak posted the survey link on the group page, the survey itself was hosted on Qualtrics, a confidential survey service. Qualtrics provides tools to configure survey properties and to customize privacy settings, so respondents cannot be tracked to an IP or email address, name or ticket number, which allows for anonymous responses. Our study was submitted for review to the IRB (institutional review board) and was exempted.\u003c/p\u003e\u003cp\u003eRESULTS: 372 MAM members (approximately 2%) responded to the questionnaire, of which 335 reported using CIM; between 114–139 (34–42%) found CIM modalities to be at least mildly effective. Of note, 164 (49%) reported using cannabis derivatives or cannabinoids, specifically with, 64/164 (39%) reporting that cannabis was not effective for them.\u003c/p\u003e\u003cp\u003eCONCLUSIONS: This study provides an initial investigation into the demographic and practice patterns of patients who use CIM. While it must this sampling may not reflect CIM use across all individuals with migraine, it does strongly suggest the need for better education on the role of, and evidence for, CIM among headache care providers, and the need to ask patients specifically about their use of and interest in CIM.\u003c/p\u003e","manuscriptTitle":"A Patient perspective of Complementary and Integrative Medicine (CIM) for Migraine Treatment: A social media survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-05-04 19:22:27","doi":"10.21203/rs.3.rs-25263/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8729b7fc-d0ef-491c-93f1-5348d805a956","owner":[],"postedDate":"May 4th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":93441,"name":"Neurology"}],"tags":[],"updatedAt":"2020-05-04T19:22:28+00:00","versionOfRecord":[],"versionCreatedAt":"2020-05-04 19:22:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-25263","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-25263","identity":"rs-25263","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}