Behavioral Treatments of Chronic Tension‐Type Headache in Adults: Are They Beneficial?

Abstract

To assess the efficacy of behavioral treatments in patients with tension headache. Medline, Cinahl, EMBASE, and the Cochrane library were searched from inception to October 2007 and reference lists were checked. We selected randomized trials evaluating behavioral treatments (e.g., relaxation, electromyographic [EMG] biofeedback, and cognitive behavioral training) in patients with tension-type headache (TTH). We assessed the risk of bias using the Delphi list and extracted data from the original reports. A qualitative analysis was carried out. We found 44 trials (2618 patients), which were included in this review, of which only 5 studies (11.4%) were considered to have low risk of bias. Most trials lacked adequate power to show statistical significant differences, but frequently, recovery/improvement rates did not reach clinical relevance. In 8 studies, relaxation treatment was compared with waiting list conditions, and in 11 studies, biofeedback was compared with waiting list conditions, both showing inconsistent results. On the basis of the available literature, we found no indications that relaxation, EMG biofeedback, or cognitive behavioral treatment is better than no treatment, waiting list, or placebo controls.

Headache: the Placebo Effects in the Control Groups in Randomized Clinical Trials; an Analysis of Systematic Reviews

“…In total, there were 13 control groups (n = 133) that received a treatment designed to be consistent with the therapy in the active treatment groups, but without the specific active elements of the treatment. 9,11,12,14,16 This enabled the researchers to control also for attention, expectations of improvement, information, contact with the investigator, and medical equipment. There were many forms of pseudo-EMG biofeedback.…”

“…In pharmacological studies, 34 placebo control groups (n = 1017 participants) were found on prophylactic medication 9,11,12,15 and 44 placebo control groups (n = 5369) on acute medication. 10,11,13 In 57.7% of these 78 control groups, the placebo was described as "identical in shape or color" or "matching"; in 6.4%, the placebo was identical and had the same taste. In the remaining 35.9%, no specific description besides the word placebo was given.…”

“…In total, there were 20 control groups including a WLC (n = 279). 11,12,14,16 Participants in these studies were placed on a waiting list. In most of the cases, they were told that the treatment groups were temporarily filled and the treatment would start within 2 to 12 weeks.…”

“…[9][10][11][12][13][14][15][16] From this data set, RCTs with a "no treatment" or placebo control group were selected for review. Studies with missing data on the outcome measures were excluded.…”

“…Overall, 42 studies (35.3%) were considered to be of high quality (or low risk of bias); 35 of these were pharmacological studies, and 7 were nonpharmacological studies. [9][10][11][13][14][15][16] Interventions…”