Migraines

Acupuncture is the holistic option with the strongest evidence for preventing migraine, though its advantage over sham treatment is small. Some headache symptoms need emergency care, and a doctor can review medicines for attacks and prevention.

When to see a medical doctor first

These warning signs come from the American Academy of Family Physicians' 2022 review of headache in adults, with a few extra items from MedlinePlus and the NHS.

• Emergency care: a sudden, severe headache that reaches full intensity within seconds or minutes needs emergency care right away. A headache with weakness, numbness, confusion, trouble speaking or vision loss is an emergency; call 911. So is a headache with fever and a neck so stiff you can't touch your chin to your chest (MedlinePlus).
• See a clinician soon: a new headache that starts at age 50 or older, because it can signal conditions such as giant cell arteritis, which needs urgent blood tests.
• Also on the NHS list: a seizure or a recent head injury needs emergency care. Get same-day care for a migraine lasting more than 72 hours, an aura lasting more than an hour, or migraine during pregnancy or after recently giving birth. See a doctor if attacks are getting worse, happen more than once a week, are hard to control, or come regularly before or during periods.

What a medical workup usually checks first

A doctor first checks for the warning signs above and does a neurological exam. According to the AAFP review, headaches with a stable pattern and a normal neurological exam generally don't need imaging. Our sources do not describe a standard test panel for migraine. NHS treatment for attacks includes painkillers such as ibuprofen or acetaminophen (paracetamol), triptans, gepants and anti-sickness medicines. For prevention, it lists beta blockers, some antidepressants and anti-seizure medicines, acupuncture, relaxation or CBT, and vitamin B2 (riboflavin).

What the evidence says about holistic options

Therapy	Evidence	Notes
Acupuncture	Supported	May reduce how often migraines happen, and works better than no treatment, with a small effect versus sham (NCCIH). A Cochrane review pooled 22 trials and 4,985 people.
Chiropractic or spinal manipulation	Mixed/limited	Low-quality evidence of modest benefit over usual care. Moderate-quality evidence favors it over sham for headache that starts in the neck (cervicogenic). Rare strokes have been reported after neck manipulation.
Massage	Mixed/limited	Few studies, with inconsistent results.
Relaxation and biofeedback	Mixed/limited	The NHS lists relaxation or CBT for prevention.
Riboflavin (vitamin B2)	Mixed/limited	The NHS lists it for prevention. A 2025 review of headache supplements says it can be recommended for adults.
Magnesium; coenzyme Q10	Mixed/limited	The same 2025 review recommends magnesium for prevention and gives coenzyme Q10 a weaker (Level C) rating. Ask about dose, and about interactions with current medicines.
Feverfew	Mixed/limited	No current American Academy of Neurology rating (see the note below the table).
Butterbur	Mixed/limited	Can contain compounds that harm the liver, and severe liver injury has been reported, including cases that needed a transplant (2019 case review).
Naturopathic or functional medicine	Unconfirmed	No source found.

A 2012 American Academy of Neurology and American Headache Society guideline once rated butterbur, magnesium, riboflavin and feverfew for migraine prevention. The AAN retired that guideline in 2015 over safety concerns about butterbur, so its ratings are no longer AAN advice. Riboflavin and magnesium are the supplements with the most support for migraine prevention in adults, and butterbur carries liver-safety concerns (Tepper and Tepper, 2025). We found no completed Cochrane review of riboflavin, magnesium or butterbur for migraine; a Cochrane review of magnesium is still at the protocol stage.

Unconfirmed means we found no source in this review. It is not a verdict either way.

Who people see for migraines on this site

• Acupuncture clinics.
• Integrative medicine doctors, who are licensed MDs or DOs.
• Naturopathic doctors in our directory, who are not licensed in New York.
• Chiropractors and massage therapists.

You can check a New York license on the NYSED verification search.

Questions to ask a practitioner

• Which headache features would make you refer to a physician before treating?
• Which preventive options have evidence, and do any interact with current medicines, for example butterbur's liver concerns or high-dose magnesium?
• If you offer neck manipulation, how do you screen for stroke risk and discuss the rare reports?

Last reviewed: October 2026

Sources

• American Family Physician, Acute headache in adults: a diagnostic approach (September 2022)
• MedlinePlus, Neck pain (reviewed 14 January 2026)
• Holland et al., AAN/AHS guideline on NSAIDs and complementary treatments for migraine prevention (2012; retired by the AAN in September 2015)
• Tepper SJ and Tepper K, Nutraceuticals and headache 2024, Current Neurology and Neuroscience Reports (January 2025)
• Rodriguez et al., Magnesium for migraine prevention (Cochrane protocol CD016307) (November 2025)
• Anderson and Borlak, Hepatobiliary events with a butterbur extract, Journal of Clinical Medicine (2019)
• NHS, Migraine (reviewed 10 March 2026)
• NCCIH, Headaches and complementary health approaches (June 2023)
• American Family Physician, summary of the Cochrane review of acupuncture for migraine (2017)
• NYSED Office of the Professions, online license verification