Do Viral Migraine Remedies Work? Breaking Down the Science 

Episode 240: Do Viral Migraine Remedies Work? Breaking Down the Science

Lindsay Weitzel, PhD:
Hello, everyone, and welcome to HeadWise, the videocast and podcast of the National Headache Foundation. I’m Dr. Lindsay Weitzel and the founder of MigraineNation, and I have a history of chronic and daily migraine that began at the age of four.

Today we have sort of a fun episode in store. We are here with Dr. Fred Cohen. Dr. Cohen is a repeat guest because he’s so fun and so knowledgeable. He is an assistant professor at the Icahn School of Medicine at Mount Sinai. He’s also the Medical Director of Headache Intervention. Hello, Dr. Cohen, how are you today?

Fred Cohen, MD:
Hi. Thank you for having me again.

Lindsay Weitzel, PhD:
Well, thank you for being here. Our episode is going to be kind of interesting and fun, and I think everyone’s going to get something out of it. We are going to go through some of the rumored headache cures, not cures, but let’s say interventions for headache or abortive things that we can do to abort a migraine, that we have seen online, on TikTok, etc. And we’re just going to talk about them and say whether or not they might have some validity to them, whether or not they might help, or whether or not they are just absolutely out of nowhere. I’m going to run down the list that we’ve come up with, and Dr. Cohen is going to say what he thinks of them and say a little tidbit about each one of them.

We’re going to start with one that’s pretty common. Everyone’s heard of it, maybe even tried it. What do we think of having some caffeine or coffee when we get a migraine?

Fred Cohen, MD:
Before going into it, I just want to state that when it comes to these, if you want to say home remedies, I do encourage patients to try sort of home stuff, because treating a migraine it’s not just here’s a pharmaceutical pill. Lifestyle modifications are important. I tell patients when they bring these, that a lot of times they bring ideas to me, and I always encourage that. And I encourage you guys to do as well, because the last thing I want any patient to do is something that might be harmful. There have been times that a patient’s come to me with like, oh, I want to try this something. And I look at it, and I go, hold on, this might have more harm than good. But with caffeine, widespread, it’s a double-edged sword. For many people, it can help headache and migraine attacks, but others it could trigger it.

So, what does caffeine do, I guess is the best place to start with. Caffeine, while it has numerous effects in our body, can raise blood pressure, can increase heart rate. In the brain, in the nervous system, it causes vasoconstriction of blood vessels. And first that doesn’t sound good, but it actually can be a useful goal in migraine attacks, because during a migraine attack, there’s all these inflammatory markers, and things etc. that’s coursing through the blood vessels. And by constricting it, it slows the release down.

So, a common medication, the triptans, sumatriptan, rizatriptan. Triptans actually work by causing vasoconstriction. Not the same as caffeine, but it’s a similar end. However, again as I was saying, caffeine can raise blood pressure, heart rate, and therefore for some it can trigger a headache or migraine attack. So, with all these remedies we’re going to bring up, I always say what works for some may not work for you, etc.

Caffeine, it’s why we see it in medications such as Excedrin, Fiorinol, etc. because again, for a lot of people they see relief with it. I get asked a lot what’s too much caffeine? That’s a very good question. I would say no more than 300 or 400mg, which is around 3 to 4 cups of coffee in a day. I ask a lot of patients oh how much coffee do you drink? And they get really like concerned. No, coffee’s okay, but like everything else in moderation. So caffeine can be useful.

Lindsay Weitzel, PhD:
Let’s move on to something more simplistic. I used to do this all the time when I was a little kid. I haven’t done it in a while, but cold wrap on your head or ice on your head, how helpful is this?

Fred Cohen, MD:
Absolutely. I’ve done this when I was a kid, before I even knew my headaches were migraine attacks. So cold or even warm wraps, hats, etc. we’ve heard of migraine hats, headache hats, etc. and they can be very useful. And how they sort of work is like neuromodulation. A lot of the things we’re going to talk about mimic popular devices such as Cefaly, gammaCore, Nerivio, etc. These are all things that are causing a neuromodulation effect.

What I mean by neuromodulation is something is sending a signal to the brain, a stimulus. And that’s augmenting other nerves, in this case pain. So having cold compress, again I want to put cold and warm. For me cold helps, warm doesn’t. And I have many patients it’s the opposite and that’s fine. It doesn’t indicate anything. What works for you, works for you.

Again, we’re giving this different stimulus. And that in turn is sort of changing the neural pathways, if you will, and augmenting what pain pathways are on. This is why, and it’s a very easy to use treatment. You could use a cold rag. That’s why just get a hand towel, run under cold water or ice.

They make a lot of products that are easy, headband or even a hat that goes over your head is what I see them using. Just make sure it’s not too cold or too hot. Obviously, if it’s too hot, you don’t want to burn yourself. If it’s too cold, that could cause harm, not to the point where it’s causing pain, but they can be very easy and useful things.

Lindsay Weitzel, PhD:
This one’s sort of related because I have seen people do both at the same time. Cold wrap on head and then put their hands and/or feet in warm water.

Fred Cohen, MD:
The hot water thing I’ve seen it’s rounds on TikTok and Instagram and I would say the evidence is sort of weak for this. So, the explanation that people have given for this is that it causes vasodilation in the legs and therefore improves circulation. First, I want to say, listen, putting your feet in warm water shouldn’t harm you as long as it’s not boiling hot water and there’s no issue with your feet. Again, a lot of these I make sure isn’t going to harm my patient. I don’t think this is going to be harmful, but compared to the previous ones we talked about, there isn’t much evidence for the feet in warm water.

Lindsay Weitzel, PhD:
We’re going to move on to one that’s even more fun. I can’t even say it without laughing. I’m sorry. Rubbing mustard on your feet. Is this going to help your migraine?

Fred Cohen, MD:
I saw this on TikTok and I actually made a reply video on my TikTok about it because I thought it was absurd. So, I don’t know who came up with this. And I saw it in multiple videos, so I couldn’t be like, oh, it’s a one off. No, it was multiple. And it’s usually combined where you rub mustard on your feet and put it in hot water.

My only thought is that the authors of these videos maybe think it’s something like capsaicin spice. So, we know certain chemicals like capsaicin, which is what is the actual molecular chemical fuel that causes spice to have anti-inflammatory, anti-pain properties. Mustard can be spicy. It’s not capsaicin. So no, there’s no evidence of putting mustard on your feet. Just keep the mustard for hot dogs and burgers.

Lindsay Weitzel, PhD:
Well let’s move on to the capsaicin then, because that’s on our list. Some people actually will spray that in their nose. I can’t imagine how that would feel. Or there’s topical capsaicin. Is that helpful?

Fred Cohen, MD:
Capsaicin, as I said, is the chemical of spice, is what makes us taste spicy. For some it can irritate stomach if they’re intolerant to spicy food. It also has an anti-pain component. So, it exists in both a spray form as you’re saying, a pill form, and a topical form. These sprays are a bit too hard core. I don’t typically recommend this spray. I know patients who do it. It’s going to irritate you. Just imagine what happens when you sniff pepper, like it’s going to do that. I typically recommend the ointment or cream. You could rub it around your head. Be very careful where you rub it and wash your hands after. If you rub your eyes, it’s going to hurt a lot. I make it very clear. Patients, when you use this, please be sure to avoid anywhere by your eyes. Make sure you’re not sweating in a hot place. Wash your hands thoroughly. Scratching your nose, going to the bathroom, it can be very problematic. So be sure your hands are clean. I’ve heard of a case where back when I was a resident in a hospital of someone using it, then changing their child’s diaper. It led to a lot of discomfort. Again, just be very mindful of your hands.

We also use it as some people watching might know about abdominal migraine. Chronic nausea is associated with migraine. When I was practicing more internal medicine, we would use capsaicin cream a lot for people that or cyclic vomiting syndrome, rubbing it on your tummy can actually have a very good effect.

Lindsay Weitzel, PhD:
Interesting. Let’s move on to one that is super fun. Place a banana peel on your forehead.

Fred Cohen, MD:
I’ve heard that being good for your skin like as a natural moisturizer in a way. I’ve seen dermatologists and people on social media doing that. For headaches, I don’t think there’s any evidence of what it’s going to do. My thought hearing a banana peel is probably potassium. Potassium is a questionable supplement about taking it in a migraine because we know in… so the aura phase, those who have aura, the visual symptoms and whatnot, it’s thought to be caused by something called cortical spreading depression. Think of this big wave of nerve polarization around your head. That’s actually the release of potassium. My assumption is people thinking of bananas or potassium are thinking that. You’re not going to really get absorption into your brain or whatnot using a peel. So, if you want to do it for skin, all right. But for migraine, I don’t see evidence in that.

Lindsay Weitzel, PhD:
The next one that seems very popular, they seem to specify McDonald’s for some reason. I don’t know if it has to be McDonald’s, but people love to say McDonald’s, coke, and fries.

Fred Cohen, MD:
I have heard this a lot, and I got to be honest, I’ve not tried it. Maybe I got to give this a try. I have heard this a lot. So, I can think of two possible reasons. One, coke has caffeine. I do hear McDonald’s coke is like the pinnacle. I was on a road trip going down to a wedding in Virginia recently, and my friends in the car were like, oh, let’s stop to get a drink. We got to go to McDonald’s because I want that coke. Another kind of coke wouldn’t suffice.

But my thought is the caffeine in that, because as we discussed before, caffeine. I don’t know if McDonald’s has like some secret ingredient that they’re withholding from the migraine world. Maybe we can make a drug with it. I don’t know, but I just think it’s the caffeine. And then with the fries, one McDonald’s has good fries, in my opinion. I’m not sponsored by the McDonald’s. But I just think that’s salt maybe, because salt for many people could be a therapeutic kind of remedy for numerous reasons. It’s electrolytes. It changes your fluid balance. You might drink more water with it. But as far as directly with, again, McDonald’s like their own fry, no. I think it’s caffeine and salt in something that you enjoy. Given that this is fast food, sugary, use with moderation. I’m not going to make the recommendation all right make sure you have your daily McDonald’s, coke, and fries.

Lindsay Weitzel, PhD:
I still, just to interject, I still to this day, my whole life, that is something I crave is coke and something salty with my pain. So, don’t know how to categorize that, but some of us sure crave it. So, the next one, I actually have a family member who in the 80s a doctor told her to do this for her migraines: cut your hair off.

Fred Cohen, MD:
Cutting hair, that’s an extreme, so I wouldn’t recommend that. I think why someone might do that or be recommended is many with migraine, myself included, you probably have experienced what is known as allodynia or some interesting skin sensation. I’ll give you an example. For myself on this side it will feel like there’s a belt here. There’s many ways to categorize this. This is a subjective thing, but it’s essentially increased skin sensation. For some, they might feel their hair and therefore be inclined to oh, it’s my hair, to shave their head. I would find it astonishing for also a doctor to recommend it. I won’t recommend that it will cure the allodynia. Proper migraine treatment should improve their allodynia.

So, no. And again, to really get into the science of it, the generation of a migraine attack, we know where the attack is coming from the trigeminal vascular pathway. The hair has nothing to do with that. The reason why we feel the pain of a migraine around the head and not inside our brain where the migraine generator is, when all these signals are going out, the end stage of a migraine, why there’s pain, is it causes sensitization of our meninges in the outer layer of the head. Our brains can’t feel pain. If I somehow was to cut the inside your brain, there wouldn’t be pain. So, the reason why we feel that pain is that product. And while our hair is in our scalp and whatnot, I can understand why some may think that. So, I don’t recommend cutting your hair off.

Lindsay Weitzel, PhD:
I think in this case too, she had a particularly thick hair, and they were thinking the weight of it was increasing the problem.

Fred Cohen, MD:
I heard of that from tension headache, cervicogenic headache. But naturally your hair wouldn’t do that. If you’re obviously in a ponytail or something like that, that’s a different story. Your hair shouldn’t naturally be pulling like that.

Lindsay Weitzel, PhD:
Right. Well, she was not cured after cutting off her hair. I can give the end of that story. So, this one I find super strange, but hold a lemon wedge.

Fred Cohen, MD:
Lemons. So, holding a lemon wedge to your nose, to your face, just holding it? Or I guess that’s my counter question to you. Using a lemon how?

Lindsay Weitzel, PhD:
I don’t know. I think that in our conversations together, we were thinking maybe if you sniffed the lemon, maybe that’s probably more helpful than just holding it and absorbing its magical lemon properties.

Fred Cohen, MD:
So, lemons actually, we once looked at for this for headache decades and go I believe in the early 60s. I learned this from my mentor Dr. Silberstein. Lemons were actually found to have an antidepressant component. In lemons what gives part of its scent is something called terpenes. Terpenes is a kind of aromatic chemical that causes a certain smell, from bad to good. And in lemons that citrusy smell is coming from that. Terpines could be a very, I guess, one powerful chemical messenger. And it can achieve a lot of effects in the central nervous system. In regards to this study, they found that those are depression, sniffing the lemon there was reported to improve their mood. Now how much, this was a small study again done decades and decades ago.

But extrapolating from that data, there has also been evidence that terpenes can also have a pain relief component. So, I could totally see that. And that maybe that terpene effect can achieve that. Sniffing a lemon shouldn’t cause, of course, any harm. I also want to stress when we talk about this, we’re talking about natural lemons, meaning I’ve seen people buy… what’s it called?

Lindsay Weitzel, PhD:
Aromatic.

Fred Cohen, MD:
Aromatic, like the essential oil diffusers with a lemon scent. That’s not the same or sniffing lemon juice. You need a real lemon that has the terpene chemical. Using anything else is not doing that effect. So that’s something you want to just try, have a lemon tree in your house. I actually want to have a lemon tree by my balcony door. Lemon trees are toxic to cats, so that’s why I don’t have one. So be aware of that. Lemon trees are toxic to cats.

Lindsay Weitzel, PhD:
This one is pretty popular. Lots of questions in social media about daith piercing. And I guess recently also, nose septum piercing, to be helpful possibly with migraine symptoms.

Fred Cohen, MD:
I’ve seen plenty of daith piercings. Explaining what daith piercing is, so it’s a piercing that goes in sort of the inner cartilage, like the inner portion of your ear, meaning it’s not hanging on your lobe. It’s going in here and it’s just a simple ring. And the thought behind it is piercing that area has some kind of neuromodulation effect.

There’s been several studies. It’s a bit muddied. It’s yes and no. I have had patients that report it helps. I have a lot of people say it helps for like a year, then it went back to normal. I don’t recommend it outright, but if a patient asks, I tell them, do you want a piercing? If you want a piercing, if you like a piercing, sure. But if you don’t want to get your ears pierced, then no, I don’t recommend that. But again, if you like the esthetic of it, then I don’t think they cause harm, so absolutely.

Nose septum, unlike daith piercing, there isn’t really any evidence. That’s all anecdotal, so therefore, I tell patients, do you want that look? If you want that look, okay. But unlike daith piercing, there aren’t any credible studies.

Lindsay Weitzel, PhD:
So next one is marijuana. I know that that’s been studied more and more in relation to migraine.

Fred Cohen, MD:
So first, legal statement, obviously adhere to your state laws. Because this is an illegal substance in certain states. You know, where I reside in the state of New York and you in the state of Colorado where it’s both medically or recreational. So first I want to stand up when we talk about this. Please adhere to your state laws.

So marijuana, as many people know, has pain relief effects. It’s been well used in a lot of people with cancer pain, chronic back pain. And there has been several studies looking at it for acute migraine relief, the most recent one being in 2024. And it was shown to be effective. So, there is evidence to use it as an acute migraine treatment.

Now of course if that’s something you wish to try, I highly recommend that you speak to someone who has a medical marijuana prescribing license because they are experienced to say how to get it, how to use it. I wouldn’t call this the same as going to your recreational dispensary. These trials have had actually certain combination of THC and CBD. So that’s why I always recommend going to a medical marijuana prescriber.

And the reason why we think it helps is we do know the endogenous, the body’s cannabinoid receptors, where the can of the cannabis is targeting, also has a sort of natural opioid effect. Now, when I say opioids, I mean the opioid receptor. This is not an opiate. This is not codeine. This is not oxycodone. No, no, no. But meaning that it’s sort of has a similar effect to what receptors it’s working on. And that’s why we think there is pain relief with it.

Lindsay Weitzel, PhD:
Then let’s move on to, there are many products like this, the homeopathic type oils that we roll on. One of them that’s kind of common is called HeadOn pain relief. Do these help migraine symptoms?

Fred Cohen, MD:
So, with any topical, because before we were talking about topical capsaicin and whatnot, there’s also topical lidocaine etc., it’s very important to know the active ingredient. The example is HeadOn, which I remember that commercial and its probably many people remember seeing it was something that you applied to your forehead. But it was found to be essentially that the active ingredients, there isn’t any NSAID or something in it, so it’s questionable if you want pain relief. And while there might not be a downside to it, like for instance, I didn’t think there was a harmful effect of using something like that. Any of those, I always recommend showing your doctor to see what the active ingredient is, because it’s not like the same of, I would say, taking ibuprofen or whatnot.

Like an NSAID that we know is a medicine. It could be the ingredients can range between essential oils or can be certain herbs. And again, for the most part that shouldn’t cause harm. But with this, again, when it comes to these over-the-counter stuff, there’s a lot less FDA regulation. A lot of people assume, oh, if I buy it at a pharmacy over the counter, it has to be safe. And it’s probably true to a degree, but how you use it. So that’s why any of these kinds of over-the-counter things, I always, and if you look at all these things in the back, they usually say not clinically trialed or if used longer than two weeks, should talk to your doctor. It’s there for a reason. So, any of these homeopathic treatments always I say present to your doctor. Of course you never want to do harm.

Lindsay Weitzel, PhD:
I have one more on my list and you came up with this one. I did not know this was a thing. We know that we have vagus stimulators that have some data behind them and that we can purchase or go through our insurance etc., but how about vagus stimulation with your hands, manual stimulation. Is this something that’s helpful?

Fred Cohen, MD:
This goes back to neuromodulation, meaning, there are devices that achieve this like gammaCore and what I’m talking about is your vagus nerve runs from your head down into the neck, and it controls a lot of our autonomic and parasympathetic nervous system components. We know that with those devices, for instance, it’s causing an effect.

But also rubbing that area or humming can do it, but not to the same amount. Meaning that when patients bring that up there, don’t rub here too hard, irritate your muscle. You have important blood vessels there. What I tell patients is if you’re curious about that, then not a half measure. Get one of the FDA approved vagus nerve stimulating devices such as gammaCore.

And again, there’s many neuromodulation devices. Neuromodulation, I think, is a great category because it usually doesn’t need a prescription. The only really side effect on them is skin irritation. It’s not like taking a pill or a shot. There are neuromodulation that go to your forehead. We just talked about the neck, back and head, even your arm. It was nice, but it is again it’s a non-prescription low adverse effect risk. So, you find that maybe doing this helps, take it to the next level.

Lindsay Weitzel, PhD:
That is everything on my list. Is there anything that you would like to say to sum up this topic before we go today?

Fred Cohen, MD:
There’s many different things, I’m sure scouring social media, the internet, talking to your friends, you might find other things. And again, I don’t per se discourage patients. I encourage them to bring it forward to their provider. I always ask in my initial visits, it’s something to ask, are you doing home remedies? Because again, I am in my work, especially when I used to be a primary care doctor, I would find patients taking certain supplements. I’m like whoa, whoa, whoa. Long term, this could be harmful. So, it’s always good to ask. And if you want to know more about this on my Insta and TikTok @fredcohenmd, I typically evaluate these popular viral videos and give my comments, whether I think they’re good or if they’re harmful. So if you want to know more remedies, give a follow there or also on my blog at headache123.com.

Lindsay Weitzel, PhD:
Thank you so much for being here and tackling this fun topic with us. And thank you everyone for joining. Please join us again on our next episode of HeadWise. Bye bye.

Fred Cohen, MD:
Thank you. Always a pleasure to be here.

Lindsay Weitzel, PhD:
And thanks again.

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