Traditional medicine use and unmet migraine needs: findings from a cohort study

Traditional, complementary and integrative medicine (TCIM) is frequently used by people with migraine, but epidemiological studies commonly reduce this behavior to a binary measure. A recent Berlin substudy of the German National Cohort classified TCIM use according to the number of modalities and frequency of use. Migraine diagnosis was not independently associated with any pattern, whereas users of migraine-specific medication showed numerically higher, but statistically non-significant, estimates for multimodal patterns. This finding should not be interpreted as evidence that medication failure causes TCIM use. Instead, it supports a testable, pattern-based framework. Single rare use may represent experimentation; single frequent use, selective consolidation; multiple rare use, an ongoing therapeutic search; and mixed frequent use, integrated selfmanagement. Each pattern also has competing explanations involving access, cost, habit, culture, perceived benefit, and disease burden. Clinicians should therefore ask what is used, how often, for what purpose, with what perceived effect, and alongside which medications. Longitudinal studies that measure migraine burden, treatment response, motivation, safety, and transitions between patterns are needed. Pattern-based characterization may improve patient-centered care and generate hypotheses, but it cannot establish unmet need from cross-sectional data alone.