N ew painkilling medications have brought welcome relief to millions of migraine sufferers. But medications aren't the only effective weapons against migraine.

Many alternative therapies, from acupuncture to nutritional supplements, can enhance the effectiveness of migraine drugs. In some cases, they eliminate the need for drugs altogether.

STRESS MANAGEMENT

Psychological stress can trigger migraines. Some migraineurs get headaches during periods of intense stress. Others get "let-down" headaches after stress has subsided.

By retraining your nervous system, biofeedback can be extremely effective at countering psychological stress.

It doesn't have to be conventional biofeedback, in which the patient--hooked up to electrodes--monitors his/her anxiety level via visual or audible signals. Almost any relaxation technique can work--including meditation, yoga, self-hypnosis, progressive relaxation or tai chi.

ELIMINATING CAFFEINE

In small amounts, caffeine eases migraine pain. Not surprisingly, many aspirin-based painkillers contain caffeine... and migraineurs often gulp coffee at the first sign of pain.

But among those who consume more than the equivalent of two cups of coffee a day, skipping a cup can cause caffeine withdrawal. That can trigger migraine.

Lesson: Migraineurs who drink lots of caffeinated coffee, tea or cola--or eat lots of chocolate, which also contains caffeine--can benefit by giving up their habit.

DIETARY TRIGGERS

Headache frequency and severity can be reduced by avoiding certain food triggers...

Aged cheese, red wine, pickled food, bananas, figs and other foods containing the amino acid tyramine.

Yogurt, beer, freshly baked bread and other fermented foods.

Dried fruit. Most contain sulfites, preservatives that can trigger headaches. Raisins contain a red pigment that can trig-ger migraine.

Foods containing nitrites and/or monosodium glutamate (MSG).

Bread and pasta made from wheat. Although true wheat sensitivity is rare, some migraineurs find that avoiding wheat helps curb their headaches.

SLEEP HABITS

Migraines can be triggered by getting too little sleep--or too much. Aim for eight hours of sleep a night. Do not try to "catch up" by sleeping late on weekends. Take short naps during the day instead.

VITAMINS AND MINERALS

Magnesium plays a key role in brain function. Among other things, it influences blood vessel dilation and serotonin levels--each of which is a factor in migraine pain.

Up to 50% of migraineurs have a magnesium deficiency, according to recent research.

Spinach and other dark-green, leafy vegetables are rich in magnesium. But other good magnesium sources--including nuts and beans--contain compounds that can trigger migraines. For this reason, it's hard to correct a magnesium deficiency through diet alone.

Better: Ask your doctor about taking a supplement containing 300 mg to 600 mg of magnesium per day.

Also helpful: Vitamin B-2 (riboflavin) supplements. A double-blind study published last year in the journal Neurology found that taking 400 mg a day significantly reduced migraine frequency.

You may have to take B-2 supplements for up to four months before you notice any effect.

FEVERFEW

Feverfew, an herb related to chamomile, has been used against migraine for centuries. Recent studies have found that daily use of feverfew reduces migraine frequency by up to 25%.

Feverfew is sold at health-food stores. The usual dosage is 100 mg a day.

ACUPUNCTURE AND MASSAGE

Acupuncture can be quite effective at relieving migraine pain. You might try one 20- to 30-minute session a week for 10 weeks as a preventive measure... plus periodic "touch-ups" if headaches recur.

For the name of an acupuncturist in your area, contact the American Academy of Medical Acupuncture at 800-521-2262.

Massage fights migraine indirectly, by relieving stress. But certain forms of massage seem to do more to relieve migraine than simply relieve stress.

These migraine-fighting massage techniques--described by Toru Namikoshi in his 1985 classic Shiatsu and Stretching--have proven to be particularly effective...

Place your thumbs on each side of the spine, in the hollows between the neck muscles just below the base of the skull. Tilt your head back. Press firmly for two to three minutes, breathing deeply as you do.

Press the web between your thumb and forefinger with the thumb and index finger of your opposite hand. Press hard for one minute, breathing deeply. Repeat with the other hand.

WHEN MEDICATION IS NEEDED

The 1993 introduction of sumatriptan (Imitrex) was hailed as a breakthrough for migraine sufferers--and no wonder.

Taken at the first sign of migraine, this prescription medication constricts dilated blood vessels, relieving not only pain but also the nausea and sensitivity to light and noise that often accompany migraine headaches.

Sumatriptan can be taken orally or--for faster relief--sprayed into the nose or injected.

Unfortunately, sumatriptan can cause unpleasant side effects, including chest pressure and a transient rise in blood pressure.

Sumatriptan and the newer "triptans," including zolmitriptan (Zomig), rizatriptan (Maxalt) and naratriptan (Amerge), are off limits for most heart patients and individuals at risk for heart disease.

Other drugs proven effective in preventing migraine include...

Anticonvulsants, such as valproic acid (Depakote) and gabapentin (Neurontin).

Antidepressants. Tricyclics, such as nortriptyline (Pamelor), imipramine (Tofranil) and desipramine (Norpramin), are most effective.

Beta-blockers, such as propranolol (Inderal) and atenolol (Tenormin).