Cognitive Behavioral Therapy for Migraine Headache: A Systematic Review and Meta-Analysis

Abstract

Background and Objectives: Migraine headaches are chronic neurological diseases that reduce the quality of life by causing severe headaches and autonomic nervous system dysfunction, such as facial flushing, nasal stuffiness, and sweating. Their major treatment methods include medication and cognitive behavioral therapy (CBT). CBT has been used for pain treatment and various psychogenic neurological diseases by reducing pain, disability, and emotional disorders caused by symptoms of mental illness and improving the understanding of mental health. This study aimed to evaluate the effectiveness and safety of CBT in treating migraines. Materials and Methods: Seven electronic databases were searched from the date of inception to December 2020. Randomized controlled studies (RCTs) using CBT as an intervention for migraine were included. The primary outcome of this study was to determine the frequency of migraines and the intensity of migraines on Visual Analog Scale (VAS), the frequency of drug use, Migraine Disability Assessment (MIDAS), and Headache Impact Test (HIT-6) index. The two authors independently conducted the data extraction and quality assessment of the included RCTs, and conducted meta-analysis with RevMan V.5.4. Results: Among the 373 studies, 11 RCTs were included in this systematic review. Seven out of the 11 RCTs were conducted in the USA, and four were conducted in the UK, Germany, Iran, and Italy, respectively. Headache frequency and MIDAS scores were statistically significant reduced. In the subgroup analysis, headache strength was significantly reduced. Two of the included studies reported adverse effects, including worsening of migraine intensity and frequency, respiratory symptoms, and vivid memory of a traumatic event. Conclusions: CBT for migraine effectively reduced headache frequency and MIDAS score in meta-analysis and headache intensity subgroup analysis, with few adverse events. Additional RCTs with CBT for migraine headaches are needed for a more accurate analysis.

Triggers of migraine: where do we stand?

“…Clinicians should not embrace paternalism, as the advice to avoid triggers did not prove effective in migraine prevention [54]. More reasonable seems the bio-behavioural approach as randomized controlled trials have suggested its efficacy [55,56 ▪▪ ]. The lack of evidence in favour of the trigger avoidance approach may induce unjustified behaviours that might ultimately increase the burden of disease, leading to a worsened quality of life in the unproven hope of a benefit [57].…”

Management of chronic migraine

“…Biobehavioral treatment strategies are commonly recommended for migraine in spite of several recent systematic reviews showing low level or insufficient evidence and small sample or effect sizes. [79][80][81][82] Challenges with study design and control groups also make interpretation more difficult. Several primary studies as well as systematic reviews have examined behavioral interventions for more general chronic pain, including migraine.…”

“…Biobehavioral treatment strategies are commonly recommended for migraine in spite of several recent systematic reviews showing low level or insufficient evidence and small sample or effect sizes 79808182. Challenges with study design and control groups also make interpretation more difficult.…”

Study of Risk Factors and Correlates of Migraine and Depression Comorbidity

“…In addition to risk factors such as anxiety and depression, one of the risk factors for migraine is female (Lipton R B, Fanning K M, Serrano D, et al, 2015). Like migraine, depression is diagnosed more often in women than in men (Bae J Y, Sung H K, Kwon N Y, et al, 2021). The prevalence of migraine was 13.5% in women and 6.2% in men.…”