Mechanisms and clinical applications of the valsalva maneuver in migraine relief: A mini-review

Background: Migraine headaches (MH) are often managed with pharmacologic treatments, but there is growing interest in non-pharmacologic approaches that can reduce reliance on medications. The Valsalva Maneuver (VM) may offer a novel approach to managing MH. Methods: We conducted a comprehensive literature review in this regard using Google Scholar and PubMed. The search focused on studies examining the relationship between VM and MH, various aspects of VM, and studies regarding migraine etiology. Results: Our search reviewed 4,659 articles and included 57 that discussed the relevant topics. The findings suggest that VM may serve as an effective non-pharmacological technique for reducing MH severity. Several potential mechanisms may contribute to this event, including: 1- Autonomic Nervous System (ANS) Modulation: VM influences cardiac function and the trigeminovascular system (TVS), which are dysregulated in migraine patients. 2- Vascular Regulation: Abnormal vascular resistance in the dura mater and cerebral arteries, important in migraine pathophysiology, may be alleviated through VM-induced readjustment of vasodilation and modulation of the vasoconstrictor index (VI). 3- Intracranial Pressure and Neurochemical Modulation: Controversial but intriguing mechanisms suggest that VM regulates internal air pressure within the skull sinuses, manipulates cerebrospinal fluid (CSF) pressure, induces transient hypoxic effects, and triggers the release of endogenous pain modulators, all of which could contribute to shortening MH duration. Conclusion: The VM demonstrates potential symptom-relieving benefits in MH, supported by both verified evidence and some unexplained findings. However, large-scale clinical trials on this topic are lacking to clarify the mechanism of the role of VM in MH and to establish a standardized protocol for its application.