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Complementary therapies are widely used and play an important role in the treatment of chronic pain syndromes. This review summarizes the evidences from randomized controlled trials for the effectiveness of a number of complementary therapies in migraine prophylaxis. The largest number of studies (a total of 15) is available for acupuncture. These studies are very heterogeneous in respect to interventions, methodological quality and outcome measurement, and the results are partly contradictory. The majority of trials, however, suggests that acupuncture is effective in migraine prophylaxis. The four existing, randomized and placebo-controlled trials on individualized homeopathy have shown conflicting results; clearly positive results have been reported only in the oldest, qualitatively least convincing study. Concerning herbal medicines the evidence is promising for extracts from Tanacetum parthenium (feverfew, five trials) and Petasites hybridus (one trial). Randomized trials on spinal manipulation for migraine prophylaxis have shown contradictory results. For neural therapy or complex strategies combining several complementary therapies only uncontrolled studies could be identified. In summary, there is promising evidence for the effectiveness of a number of complementary treatment options in migraine prophylaxis. Further research is clearly warranted.