Psychological interventions for migraine: a systematic review

Abstract

Migraine causes major health impairment and disability. Psychological interventions offer an addition to pharmacotherapy but they are not currently recommended by the National Institute of Clinical Excellence (NICE) or available in the National Health Service. We aimed to systematically review evidence on the efficacy of psychological interventions for migraine in adults. A search was done of MEDLINE, psychINFO, http://www.opengrey.eu, the meta-register of controlled trials and bibliographies. Twenty-four papers were included and rated independently by two people using the Yates scale, which has 35 points. Cochrane recommendations are that high quality reports score above the mid-point (18 points). Methods used in 17/24 papers were rated ‘high quality’. However, frequently descriptions of key areas such as randomisation methods were omitted. Eighteen studies measured effects of psychological interventions on headache-related outcomes, fifteen reporting significant improvements, ranging 20–67 %. Interventions also produced improvements in psychological outcomes. Few trials measured or reported improvement in disability or quality of life. We conclude that evidence supports the efficacy of psychological interventions in migraine. Over half of the studies were from the USA, which did not provide universal health care at the time of the study, so it is difficult to generalise results to typical populations in receipt of publically funded health services. We agree with the NICE recommendation that high quality pragmatic randomised controlled trials are needed in the UK.

Electronic‐Diary for Recording Headaches, Triggers, and Medication Use: Development and Evaluation

“…17 Reviews of behavioral treatment have focused on different measures derived from headache diaries (eg, composite indices based on averaging pain ratings that therefore reflect headache frequency, duration, and intensity, vs headache frequency/days), but have all used headache diaries for their dependent variables. 18,19 Presumably, a major reason for this situation, was that for many years, there was no obvious alternative to paper-based diaries for frequent recording of pain ratings. This situation changed with the advent of hand-held computers and smartphones.…”

Biofeedback and Neurofeedback in the Treatment of Migraine

“…Therefore, a comprehensive approach to solving this problem is very important, and education, to both the general population and the patients, and the raising of health care to a higher level, with ongoing support for patients suffering from a migraine, are indispensable for the formation of a healthier society. Combination of pharmacologic and behavioral treatments such as relaxation training and cognitive behavior therapy can lead to faster and better results with people who suffer from migraine [43,44]. Empirically validated behavioral treatments include biofeedback training; relaxation training, combinations of the two, stress management training, and cognitive behavioral therapy could be helpful for people with migraine headache.…”

The Economic Cost of Patients With Migraine Headache Referred to Specialist Clinics

“…Our group has previously reviewed the evidence from trials of complex interventions for headache and found generally positive results. 29 Given scarce resources, it is also crucial to assess cost-effectiveness.…”