ORIGINAL RESEARCH article
Front. Neurol.
Sec. Headache and Neurogenic Pain
This article is part of the Research TopicManagement of migraine in patients with coexistent conditions or comorbidities: from classic to novel therapiesView all 12 articles
Efficacy of the herbal medicine Chotosan following treatment with Western medications for migraine accompanied by tension-type headache
Provisionally accepted
Takafumi Tanei1*
Satoshi Yamashita2
Satoshi Maesawa3
Yusuke Nishimura1Tomotaka Ishizaki1Yoshitaka Nagashima1Yoshiki Ito3
Miki Hashida1Takahiro Suzuki1Shun Yamamoto1Toshihiko Wakabayashi2Ryuta Saito1- 1Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- 2Nagoya Garden Clinic, Nagoya, Japan
- 3Nagoya Medical Center, Nagoya, Japan
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Background: Chotosan is herbal medicine that is effective for tension-type headache (TTH). This study aimed to evaluate the efficacy of Chotosan following treatment with Western medications for migraine accompanied by TTH. Methods: This was a single-center, single-arm, and retrospective observational study. Chotosan was prescribed in the following situations: responded to Western medications but effects weakened; could not continue taking Western medications due to side effects; responded to Western medications but still had frequent headaches; and refused to take antidepressants. The primary endpoint was to determine whether monthly headache days (MHDs) were decreased one month after starting Chotosan treatment. The efficacy of Chotosan was defined as meeting two criteria: MHDs decreased by 33% or more, and the patient was willing to take and actually continued taking the medication. The efficacy rate of Chotosan, changes in monthly migraine days, changes in monthly triptan and nontriptan tablet usage, and incidence of side effects were also evaluated. Results: Of 1030 migraine patients, 51 patients were included in the analysis. Chotosan significantly reduced MHDs from a median of 19.0 [14.8-25.8] days to 14.0 [7.8-23.8] days, with an efficacy rate of 52.9%. Median monthly migraine days also decreased significantly from 3.0 [0.0-6.0] days to 1.0 [0.0-3.8] days. The median amounts of triptan and non-triptan tables decreased significantly from 6.0 [2.0-9.8] tablets to 4.0 [1.0-7.0] tablets, and median 10.0 [0.8-17.3] tablets to 5.0 [0.8-18.5] tablets, respectively. The incidence of side effects was 3.9%. Conclusion: For patients with migraine accompanied by TTH who have not responded adequately to Western medications, Chotosan is a treatment option worth considering.
Keywords: Migraine, Tension-Type Headache, Chotosan, Herbal Medicine, Kampo
Received: 02 Sep 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Tanei, Yamashita, Maesawa, Nishimura, Ishizaki, Nagashima, Ito, Hashida, Suzuki, Yamamoto, Wakabayashi and Saito. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Takafumi Tanei
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