Behavioral and prophylactic pharmacological intervention studies of pediatric migraine: an exploratory meta-analysis

Hermann, Christiane; Mirihae, kim; Blanchard, Edward B.

doi:10.1016/0304-3959(94)00210-6

Cited by 193 publications

(109 citation statements)

References 24 publications

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“…In those reviews in which nonrandomized trials were included, in no instance were significant differences observed when the outcomes in randomized (ie, higher quality) trials were compared with those in nonrandomized trials. In six reviews, 38,48,49,55,58,61 it was not possible to determine whether trials referred to as controlled were randomized or not.…”

Section: Quality Of Reviewsmentioning

confidence: 99%

Mind-Body Medicine: State of the Science, Implications for Practice

Astin¹,

Shapiro²,

Eisenberg³

et al. 2003

The Journal of the American Board of Family Medicine

422

255

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Background: Although emerging evidence during the past several decades suggests that psychosocial factors can directly influence both physiologic function and health outcomes, medicine had failed to move beyond the biomedical model, in part because of lack of exposure to the evidence base supporting the biopsychosocial model. The literature was reviewed to examine the efficacy of representative psychosocial-mind-body interventions, including relaxation, (cognitive) behavioral therapies, meditation, imagery, biofeedback, and hypnosis for several common clinical conditions.Methods: An electronic search was undertaken of the MEDLINE, PsycLIT, and the Cochrane Library databases and a manual search of the reference sections of relevant articles for related clinical trials and reviews of the literature. Studies examining mind-body interventions for psychological disorders were excluded. Owing to space limitations, studies examining more body-based therapies, such as yoga and tai chi chuan, were also not included. Data were extracted from relevant systematic reviews, metaanalyses, and randomized controlled trials.Results: Drawing principally from systematic reviews and meta-analyses, there is considerable evidence of efficacy for several mind-body therapies in the treatment of coronary artery disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatmentrelated symptoms of cancer, and improving postsurgical outcomes. We found moderate evidence of efficacy for mind-body therapies in the areas of hypertension and arthritis. Additional research is required to clarify the relative efficacy of different mind-body therapies, factors (such as specific patient characteristics) that might predict more or less successful outcomes, and mechanisms of action. Research is also necessary to examine the cost offsets associated with mind-body therapies.Conclusions: There is now considerable evidence that an array of mind-body therapies can be used as effective adjuncts to conventional medical treatment for a number of common clinical conditions. Evidence emerging within the past several decades suggests that psychosocial factors from emotional states, such as depression, behavioral dispositions, such as hostility, and psychosocial stress can directly influence both physiologic function and health outcomes. [1][2][3][4] Evidence from several converging lines of research, however, also suggests that despite seemingly widespread acknowledgment of and support for the importance of the biopsychosocial model, 5-7 psycho-

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Section: Quality Of Reviewsmentioning

confidence: 99%

Mind-Body Medicine: State of the Science, Implications for Practice

Astin¹,

Shapiro²,

Eisenberg³

et al. 2003

The Journal of the American Board of Family Medicine

422

255

View full text Add to dashboard Cite

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“…1,2 Postictal noserubbing (PIN) is another clinical sign indicative of temporal lobe seizure onset. [3][4][5][6] PIN is thought to occur in response to increased nasal secretions caused by ictal activation of the central autonomic pathways.…”

Section: Richard Wennberg MD Frcp(c)mentioning

confidence: 99%

“…[1][2][3][4][5] This study evaluated the effectiveness of an hour-long, biofeedback-assisted relaxation training (BART) session within the context of a multidisciplinary pediatric headache center. The objectives were to determine whether peripheral body temperature (PBT) changes obtained during the training session (T1) could be maintained when measured at the child's subsequent follow-up clinic visit (T2), and to summarize headache perception and quality of life at T1 and T2.…”

mentioning

confidence: 99%

A pilot study of one-session biofeedback training in pediatric headache

Powers¹,

Mitchell²,

Byars³

et al. 2001

Neurology

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Relaxation training and thermal biofeedback are promising treatments for pediatric headache. [1][2][3][4][5] This study evaluated the effectiveness of an hour-long, biofeedback-assisted relaxation training (BART) session within the context of a multidisciplinary pediatric headache center. The objectives were to determine whether peripheral body temperature (PBT) changes obtained during the training session (T1) could be maintained when measured at the child's subsequent follow-up clinic visit (T2), and to summarize headache perception and quality of life at T1 and T2.Methods. Twenty children consecutively referred for BART received standard multidisciplinary treatment and BART based on headache presentation and developmental status. The sample consisted of 10 girls and 10 boys, with a mean age of 11.6 years (SD ϭ 2.2 years). The sample was predominantly white (95%). All children were clinically diagnosed with migraine, with 90% meeting International Headache Society criteria. The sample was representative of the general population of the headache center 6 and those children referred for BART.Children were taught age-appropriate skills in deep breathing, progressive muscle relaxation, and guided imagery. PBT was monitored via a computer-based biofeedback system. Children were encouraged to practice with an audio tape at least three times each week (for 2 weeks) and at headache onset. Thereafter, the children were instructed to perform relaxation regularly on their own.PBT was measured at three time points: pretraining (PT), T1, and T2. At PT, PBT was measured before any relaxation training had occurred. At T1, PBT was measured before and after BART. At T2, PBT was assessed at the beginning of the clinic visit (prerelaxation) and 10 minutes after being instructed to "relax as you normally do" (postrelaxation). T2 data were collected at the child's first or second follow-up clinic visit after BART and before examination by members of the headache center team. The time from T1 to T2 averaged 150.7 days (SD ϭ 77.3 days). Changes in PBT (PBT ⌬) were calculated for T1 and T2 by subtracting PBT at pretraining/ relaxation from PBT post-training/relaxation. For 85% of the sample (n ϭ 17), we were also able to calculate PBT ⌬ at PT.Results. Results show that children were not able to significantly increase their PBT before BART (mean PBT ⌬ at PT ϭ 0.27°F; SD ϭ 0.70°F). However, once trained in BART, a positive change in PBT occurred at T1 (mean ϭ 3.3°F; SD ϭ 2.5°F) and T2 (mean ϭ 3.7°F; SD ϭ 4.5°F). Within-subject t-tests showed that changes were significant from PT to T1 (t ϭ Ϫ4.087; p Ͻ 0.01) and from PT to T2 (t ϭ Ϫ2.687; p Ͻ 0.02). PBT changes were maintained from T1 to T2 (t ϭ Ϫ0.427; NS: df ϭ 19). Ninety percent of children at T1 and 95% at T2 were able to obtain a positive change in PBT.Headache severity decreased from a mean of 5.0 (0 to 10 scale; 10 ϭ most pain) at T1 to 4.5 at T2. Average headache frequency decreased from 12.9 to 9.7 days/month, and duration also decreased from 6.9 to 5.2 hours. PBT ⌬ at T2 was s...

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“…Unfortunately, most of these studies 9,10,[12][13][14] have merged different types of psychological treatment and pain conditions, including tension-type headache and migraine. This approach does not allow us to claim that biofeedback is effective as a migraine prophylactic.…”

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confidence: 99%

Biofeedback as Prophylaxis for Pediatric Migraine: A Meta-analysis

et al. 2016

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CONTEXT: Migraine is a common problem in children and adolescents, but few satisfactory prophylactic treatments exist. OBJECTIVE:Our goal was to investigate the pooled evidence for the effectiveness of using biofeedback to reduce childhood migraine.DATA SOURCES: A systematic search was conducted across the databases Medline, Embase, CENTRAL, CINAHL, and PsychINFO.STUDY SELECTION: Prospective, randomized controlled trials of biofeedback for migraine among children and adolescents were located in the search.DATA EXTRACTION: Data on reduction of mean attack frequency and a series of secondary outcomes, including adverse events, were extracted. Risk of bias was also assessed.RESULTS: Forest plots were created by using a fixed effects model, and mean differences were reported. Five studies with a total of 137 participants met the inclusion criteria. Biofeedback reduced migraine frequency (mean difference, -1.97 [95% confidence interval (CI), -2.72 to -1.21]; P < .00001), attack duration (mean difference, -3.94 [95% CI, -5.57 to -2.31]; P < .00001), and headache intensity (mean difference, -1.77 [95% CI, -2.42 to -1.11]; P < .00001) compared with a waiting-list control. Biofeedback demonstrated no adjuvant effect when combined with other behavioral treatment; neither did it have significant advantages over active treatment. Only 40% of bias judgments were deemed as "low" risk. LIMITATIONS:Methodologic issues hampered the meta-analyses. Only a few studies were possible to include, and they suffered from incomplete reporting of data and risk of bias.CONCLUSIONS: Biofeedback seems to be an effective intervention for pediatric migraine, but in light of the limitations, further investigation is needed to increase our confidence in the estimate.

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Behavioral and prophylactic pharmacological intervention studies of pediatric migraine: an exploratory meta-analysis

Cited by 193 publications

References 24 publications

Mind-Body Medicine: State of the Science, Implications for Practice

Mind-Body Medicine: State of the Science, Implications for Practice

A pilot study of one-session biofeedback training in pediatric headache

Biofeedback as Prophylaxis for Pediatric Migraine: A Meta-analysis

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