Complementary and Integrative Medicine Use among Migraine Patients Using a Modified Version of I-CAM-QP: A Cross-Sectional Study

Abstract

This study aimed to determine the prevalence and associated factors of complementary and alternative medicine (CAM) use among patients with migraine using a culturally-adapted Persian version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-QP). In this cross-sectional study, 310 patients attending two neurology referral clinics were screened. After excluding 66 individuals who did not meet International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria and three incomplete questionnaires, 241 patients with ICHD-3–confirmed migraine were analyzed. The core four domains of the I-CAM-QP were preserved (CAM providers, practitioner-based therapies, herbal/supplement use, and self-help practices). Modifications were limited to contextual adaptation and included the addition of migraine-specific clinical variables, incorporation of locally prevalent Traditional Persian Medicine modalities (e.g., cupping, phlebotomy, leech therapy, lifestyle modification), reinstatement and expansion of provider categories to distinguish physician and non-physician practitioners, and supplementary items assessing disclosure and safety-related aspects of CAM use. Participants were predominantly female (78.4%), with a mean age of 38.10 ± 10.18 years and mean disease duration of 10.77 ± 8.7 years. Overall, 91.7% reported using at least one CAM modality in the preceding 12 months. Herbal medicines and dietary supplements were most common (86.7%), with herbs alone reported by 68%. Increasing age was independently associated with higher odds of total CAM use among patients with episodic migraine (AOR 1.08; 95% CI 1.00–1.16) and self-help CAM practices (AOR per year increase: 1.03; 95% CI: 1.00–1.06). Greater mean headache pain intensity was independently associated with visiting a CAM provider (AOR 1.22; 95% CI 1.02–1.47). Additionally episodic migraine was associated with self-help practices (AOR: 2.45; 95% CI: 1.22–4.09). CAM use was highly prevalent and largely self-directed, underscoring the need for structured patient–physician communication in routine migraine care.