Migraine with aura is a complex neurological condition characterized by recurrent, predominantly unilateral, pulsating headaches often accompanied by visual-sensory warning signs. In addition to genetic predisposition, autonomic dysregulation, environmental factors, and structural triggers play pivotal roles in its pathophysiology. Migraine significantly impairs quality of life, especially in high-frequency attacks [1-9]. Migraine is a genetically predisposed, complex neurological disorder characterized by recurrent, pulsating headaches, typically accompanied by nausea, photophobia, and phonophobia. The World Health Organization ranks it among the most disabling neurological conditions globally [1, 4, 5].

Classification

The International Headache Society (IHS) categorizes migraines into several subtypes [5-7] see Table 1.

Table 1: Classification and clinical characteristics of major migraine subtypes.

Complications

Potential complications include [2, 7-9] see Table 2.

Table 2: Clinically relevant complications observed in the context of migraine, especially in prolonged or refractory cases.

Diagnosis and Management

Diagnosis is based on clinical history and IHS criteria. A personalized, multimodal treatment approach is essential see Table 3.

Table 3: Overview of conventional and integrative approaches in migraine management.

This integrative approach addresses acute attacks and long-term management tailored to individual patient needs and comorbidities [1,2,5,7,10].

Neural Therapy: Principles and Application in Headache Management

Neural therapy is a regulatory medical approach involving the injection of local anesthetics-primarily procaine or lidocaine-into defined zones of the body to restore disturbed autonomic and functional regulation. It targets the autonomic nervous system, particularly the sympathetic branch, to modulate reflex arcs and promote systemic homeostasis [9-12]. Procaine and lidocaine exhibit not only anesthetic but also anti-inflammatory, vasodilatory, and sympatholytic effects. Their short half-life allows for precise, time-limited interruption of pathological stimuli without systemic burden [9,11,12].

In cases of migraine and chronic headache, neural therapy techniques such as infiltration of the pterygopalatine ganglion, stellate ganglion, and the exit points of the greater and lesser occipital nerves have proven particularly effective. These structures are closely interconnected with the trigeminal system and cranial autonomic pathways. Segmental injections and targeted interference field therapy at vegetative reference points can induce immediate and sustained relief, representing a valuable tool in integrative headache management [11-16].Conventional pharmacological treatments are frequently associated with side effects, limited efficacy, or medication overuse. In this context, integrative and low-risk approaches such as neural therapy are gaining increasing clinical relevance [17,1].

Case Presentation

The patient, Ms. C. M., aged 37, presented with a several-year history of unilateral, pulsating headaches. In recent months, the frequency (3–4 episodes/week) and severity of the attacks have intensified. Attacks were accompanied by nausea, photophobia, and phonophobia. Approximately 20% of episodes were preceded by a visual aura (e.g., scintillating scotoma). Her medical history included chronic tonsillitis and non-restorative sleep. A family history revealed that both her mother and sister had also been diagnosed with migraine.

Clinical Examination

Neurological examination yielded no abnormalities. Photophobia and phonophobia were evident during the attacks. Vital signs were within normal limits, and there were no signs of infection, focal deficits, or structural abnormalities.

Diagnosis

Based on the criteria of the International Headache Society (IHS), a diagnosis of migraine with aura was confirmed [1-3, 5,6].

Neural Therapy: Initial treatment included segmental injections with 1% procaine at C2/C3 ganglia, stellate ganglion, tonsillar region, along the trigeminal nerve pathway, and vegetative reflex zones. After just two sessions, a notable reduction in attack frequency and improvement in vegetative symptoms were observed. The rapid clinical response, ease of application in practice, and absence of systemic side effects were particularly noteworthy [11-14].

Complementary Measures:

• Use of a migraine diary to identify individual triggers
• Patient education on trigger avoidance (e.g., dehydration, sensory overload)
• Training in early recognition of aura for timely intervention
• Nutritional counseling and stress management strategies

Migraine from a Regulatory and Neural Therapy Perspective

In regulatory medicine, migraine is seen not as a symptom in isolation but as a sign of underlying dysfunction in systemic regulation. Neurovegetative imbalances, structural restrictions, and fascial tension patterns often interact, creating a complex clinical picture. Neural therapy targets these dysregulations by modulating autonomic pathways and releasing interference fields [11,12].

Musculoskeletal and Fascial Interactions

Postural imbalances, joint restrictions (notably in the cervical spine, TMJ, and sacroiliac joint), and muscle asymmetries contribute significantly to headache patterns. The patient showed marked cervical tension and postural dysfunction. This justified the inclusion of musculoskeletal interactions in the clinical analysis [22-24]. These dysfunctions propagate along myofascial chains, transmitting tension cranially. The TMJ, due to its anatomical and neural connections, often plays a pivotal role in migraine initiation via trigeminal pathways. Manual therapies, fascial release, and targeted neural therapy injections can interrupt these patterns and offer sustained relief [11,12, 16,17].

Cranio-Cervical Junction – A Functional Hub

The junction between the skull and upper cervical spine (C0–C2) represents a neurologically sensitive zone involving cranial nerves (especially CN V, X, and XI), autonomic centers, and key myofascial structures. A section has been added to the discussion including clinical justification and references supporting C2/C3 blocks in migraine management [18, 23]. Dysfunction here—through fascial restriction or chronic irritation—may lead to migraines, vertigo, tinnitus, or cardiac dysregulation. Neural therapy applied to cervical segments or occipital points offers a precise tool for regulating these disturbances and restoring autonomic balance [11-13, 18-20]. We chose segmental neural therapy for its effect on autonomic regulation. The discussion was extended to compare it with GON block and medications [18].

Temporomandibular Joint (TMJ) and Systemic Implications

Craniomandibular dysfunction (CMD) is a frequent contributor to migraines and is often overlooked. Muscular tension or occlusal imbalance affects trigeminal sensory input, enhancing pain perception. Functional interventions—jaw alignment, splint therapy, muscular release, and neural therapy—are often effective. CMD must be evaluated within a broader neuroregulatory and structural context [11,12]. TMJ dysfunction was detected during the holistic examination and was likely contributing to the patient’s headache pattern [23, 24, 25].

A Holistic Approach

Effective migraine management requires integrating structural, fascial, autonomic, and regulatory dimensions. Neural therapy stands out as a valuable method for diagnosing and treating hidden interference fields. When combined with manual medicine, nutritional regulation, and stress management, it forms a comprehensive and individualized treatment model [11,12,20,21].

Clinical Course and Outcome

After four sessions of neural therapy, the patient reported a sustained improvement. Migraine frequency was reduced to one weekly episode, with significantly decreased intensity. At a four-week follow-up, the patient's condition remained stable. Acute medication was no longer necessary. The patient expressed high satisfaction with the treatment, emphasizing the regained quality of life due to the absence of drug-induced side effects.

This case emphasizes the therapeutic potential of neural therapy in treating migraine with aura. Its mechanisms include modulation of the autonomic nervous system, stabilization of the neuroimmunological balance, and direct intervention in interference fields. Neural therapy offers a broad therapeutic range, particularly for chronic or medication-resistant cases. Reducing dependency on pharmaceuticals constitutes a significant advantage. Moreover, good patient compliance and the capacity for individualized application make neural therapy a valuable complementary modality.

In chronic migraine—a condition often deemed refractory and burdensome—this case illustrates that even minimal doses of local anesthetics, when accurately administered to the correct segmental and regulatory targets, can lead to remarkable clinical improvements. The therapeutic mechanism appears to extend beyond simple nociceptive blockade, involving restoration of neurovegetative homeostasis, resolution of interference fields, and functional reintegration of disturbed somatic-visceral networks. This highlights neural therapy as a method that not only treats symptoms but also addresses the root regulatory dysfunctions contributing to chronic headache syndromes. Neural therapy, when integrated into a holistic treatment framework, can provide an effective and patient-centered approach to managing migraine with aura. The combination of vegetative-regulatory injection therapy, trigger management, and lifestyle modification led, in this case, to sustained symptom relief and a notable reduction in medication usage.

Neural therapy's ability to regulate autonomic imbalances, modulate myofascial trigger points, and restore functional coherence across multiple physiological systems makes it a valuable and versatile tool in integrative pain management. Nearly 60% of patients achieved complete symptom remission, and the majority required only a few sessions, underscoring its efficiency, tolerability, and therapeutic potential. Neural therapy’s role in such cases is not merely supportive but potentially transformative. The minimal pharmacological load, in contrast to long-term systemic drug regimens, offers a low-risk, high-reward intervention strategy. Its individualized nature, based on segmental diagnosis and regulation-focused principles, allows for targeted therapeutic action even in patients with longstanding, multisystemic migraine patterns. This integrative and personalized logic distinguishes neural therapy as a front-line option in comprehensive headache management, especially when conventional treatments have failed or caused intolerable side effects.

Abbreviations

Autonomic nervous system (ANS)

International Headache Society (IHS)

Calcitonin Gene-Related Peptide (CGRP)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Craniomandibular dysfunction (CMD)

Temporomandibular Joint (TMJ)

Cranial nerves (CN)

Servical spine (C)

Acknowledgments

We want to express our deepest gratitude to the following individuals whose expertise and support have been invaluable in the successful completion of this manuscript:

Our special thanks go to Prof. Dr. Lorenz Fischer and Dr. Hans Barop for their outstanding contributions to anorectal therapy. Their tireless commitment to clinical practice, research, and international congresses has contributed significantly to the method's scientific recognition and dissemination. Their pioneering work integrating noise therapy into modern medicine has paved the way for further research and clinical applications.

My deepest thanks go to my academic mentor, Prof. Dr Horst Ferdinand Herget, who broadened my perspective and encouraged me early on to engage intensively with nourishing therapy, manual medicine, and interdisciplinary work. His influence led me to train with Dr. Otto Bergsmann, whose palpation techniques had a lasting impact on me, and to manual medicine under Dr. Herbert Frisch, which enabled me to practice and teach. Without his visionary support, this professional and personal path would not have been possible - for which I am deeply grateful. The authors sincerely thank Ralf Oettmeier, M. Ali Elmacioglu, and Uwe Rudolf Max Reuter for their valuable scientific contributions.

Their research on local anesthetics and the relevant literature they provided significantly enriched this publication's completeness and scientific depth. We would also like to express our gratitude to Prof. Dr. David Vinyes, whose expertise in trigger point therapy and fascial techniques has been instrumental in pain management and in the successful application of neural therapy for treating fascial adhesions. We would also like to sincerely thank Prof. Dr. Laura Pinilla Bonilla and Prof. Dr. David Vinyes. Under the editorial leadership of David Vinyes, a comprehensive, multi-author textbook on neural therapy is currently being developed. This work serves as a significant reference for Spanish-speaking countries and is being prepared in accordance with the curriculum supported by IFMANT.

Huseyin Nazlikul and Fatma Gulcin Ural Nazlikul are deeply grateful to David Vinyes and his team for the opportunity to contribute as authors to this important publication. We would also like to express our heartfelt appreciation to Prof. Dr. Laura Pinilla Bonilla for her dedicated editorial work on another comprehensive English-language neural therapy textbook, created with contributions from numerous international authors. We sincerely thank her for the opportunity given to Fatma Gulcin Ural Nazlikul and Huseyin Nazlikul to contribute as authors to four chapters of this forthcoming work. We believe that both publications, once released, will make a substantial contribution to the broader international recognition and understanding of neural therapy.

Ethical Statement

The patient provided written informed consent for the anonymized publication of this case report.

Funding

This research received no specific funding from public, commercial, or non-profit organizations.

Conflicts of Interest

The authors declare that they have no conflicts of interest related to this publication and no competing interests to disclose. The authors confirm that no competing financial interests are associated with this work. No human or animal studies were conducted by the authors for this contribution. The studies mentioned in this publication adhere to the ethical guidelines specified in their respective sources.

1. Karunaratnam I, Godage S, Rodrigo Pn, Jayawardana A. A Clinician’s Handbook on Migraine Pharmacotherapy. Uva Clin Anaesth Intensive Care. 2024.
2. Gobel H. Migraine: Diagnosis, therapy, and management (10th Ed.). (Original work published as:  Die Migrane: Diagnostik, Therapie und Ma-nagement )Stuttgart. Georg Thieme Verlag. 2017.
3. Gobel H. Successfully overcoming headaches and migraines: Eliminate causes, prevent effectively, and apply self-help strategies (9th ed.). Springer Academic. (Original work published as: Erfolgreich gegen Kopfschmerzen und Migrane, 9. Aufl.) 2020.
4. Hansen JM, Lipton RB, Dodick DW, Silberstein SD, Saper JR, Aurora SK, et al. Migraine headache is present in the aura phase: a prospective study. Neurology. 2012; 79: 2044-2049.
5. Karsan N. Pathophysiology of Migraine. Continuum. 2024; 30: 325-343.
6. Dodick DW. Management of Headache and Headache Medications. Oxford University Press. 2021.
7. Silberstein SD, Lipton RB, Dodick DW. Wolff’s Headache and Other Head Pain, (8th Edition). Oxford University Press. 2019.
8. Ashina M, Hansen JM, Do TP, Melo-Carrillo A, Burstein R, Moskowitz MA. Migraine and the trigeminovascular system-40 years and counting. Lancet Neurol. 2019; 18: 795-804.
9. Tamam Y, Tamam C, Goksel A, Tamam B, Nazlikul H. Peripheral lidocaine injection (neural therapy) in the treatment of migraine in pregnancy. J Neurological Sciences. 2017; 381: 946.
10. de Vries B, Anttila V, Freilinger T, Wessman M, Kaunisto MA, Kallela M, et al. Systematic re-evaluation of genes from candidate gene association studies in migraine using a large genome-wide association data set. Cephalalgia. 2016; 36: 604-614.
11. Nazlikul H, Ural Nazlikul FG, Bilgin MD, Acarkan T, Ozkan N, Tamam Y. Neural Therapy in Migraine: Clinical Evidence for a Holistic Therapeutic Approach – Analysis of 464 Cases. Int Clinc Med Case Rep Jour. 2025; 4: 1-7.
12. Herget HF. Kopf- und Gesichtsschmerz: Systematische Darstellung ganzheitlicher Behandlungsmoglichkeiten. KVM Verlags GmbH, Marburg. 1985.
13. Fischer L, Barop H, Ludin SM, Schaible HG. Regulation of acute reflectory hyperinflammation in viral and other diseases by means of stellate ganglion block. A conceptual view with a focus on Covid-19. Autonomic Neuroscience. 2022; 237: 102903.
14. Turk A, Nazlikul H. Stellate ganglion blockade and neural therapy approach in cardiovascular diseases. In Akgul A (Ed.), Heart, vessels and edema; in nutrition and exercise. Istanbul: Istanbul University Press. 2024; 115-124.
15. Ullrich J. On the use of stellate ganglion blockade under EEG monitoring in cervicogenic migraine accompagnee. J Neurology. 1975; 209: 3021-306.
16. Reuter U, McClure C, Liebler E, Pozo-Rosich P. Non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials. J Neurology, Neurosurgery and Psychiatry. 2019; 90: 796-804.
17. Nazlikul H. Neural therapy (3rd ed.). Nobel Medical Publishing. 2022.
18. Barop H. Textbook and Atlas of Neural Therapy: Diagnosis and Therapy with Local Anesthetics. 1st ed. Stuttgart, Germany. Thieme. 2018.
19. Nazlikul H. Noralterapi: Baska bir tedavi mumkun [Neural therapy: Another treatment is possible]. Destek Publishing. 2020.
20. Nazlikul H, Ural Nazlikul FG, Tamam Y. The Significance of Thoracic Blockages for the Autonomic Nervous System–Neural Therapy and Its Clinical Relevance. Recent Adv Clin Trials. 2025; 5: 1-17.
21. Nazlikul H, Nazlikul U. Fibromyalgia Syndrome (FMS): Neural Therapy as a Key to Pain Reduction and Quality of Life. Int Clin Med Case Rep Jour. 2025; 4: 1-25.
22. Fernandez-de-las-Penas, et al. Headache: Myofascial trigger points and migraine. 2007.
23. von Heymann W. Dizziness – An interdisciplinary symptom in the interaction between cervical spine, craniomandibular dysfunction (CMD), and the autonomic nervous system. Manuelle Medizin. 2013; 51: 23-30.
24. Goadsby, et al. Cephalalgia: C2/C3 blocks in migraine. 2017.
25. Cooper, Kleinberg. Cranio: TMJ and headache. 2007.