Psychological Treatment of Recurrent Headache in Children and Adolescents - A Meta-Analysis

Abstract

Psychologically based interventions such as relaxation training, biofeedback and cognitive-behavioural therapy are increasingly discussed as options for the treatment of migraine and tension-type headache in children and adolescents. In order to determine the state of evidence regarding the efficacy of these treatments, a meta-analysis of randomized controlled studies was conducted. In a comprehensive literature search including data from 1966 to 2004, 23 studies were found meeting the inclusion criteria. Due to the application of the random effects model, generalization of the results is possible. Specific statistical procedures were used to account for a possible publication bias. Significantly more patients improved to a clinically relevant extent (headache reduction > or =50%) in treatment conditions compared with waiting list conditions (high effect sizes). Long-term stability was also confirmed. The analysed treatments lead to improvement (up to 1 year) in headache status in children and adolescents with primary headache. However, more well-designed studies are needed to support and consolidate the conclusions of this meta-analysis and to compare the effects of psychological treatment with those of prophylactic medical interventions (in migraine), to examine potential differences between treatments, to identify moderators of efficacy and to determine effects of treatment on other health-related variables such as quality of life.

Medium-term effectiveness of online behavioral training in migraine self-management: A randomized trial controlled over 10 months

“…Additional reasons must also be explored, however, because the present attack improvement in WLCs vastly exceeded the 4%-6% in waitlist groups of former (o)BT studies (12,17,19,44,45), as well as placebo effects of 9%-10% in BT (44) or migraine rescue medications (46,47). Our participants could have admitted at a time of temporary migraine aggravation that decreased over time, but our trial seemed equally prone to this phenomenon as prior trials in (o)BT.…”

Nonpharmacologic Treatment of Functional Abdominal Pain Disorders: A Systematic Review

“…This therapeutic approach may be interesting to address in future research because it has been shown to be effective in children and adolescents with recurrent headaches as well. 77 The methodologic quality of the included studies varied from very low to moderate, and the results should therefore be interpreted cautiously. The low quality was mainly due to small sample sizes, lack of adequate follow-up, substantial dropout rates, or considerable risk of bias.…”

Biofeedback as Prophylaxis for Pediatric Migraine: A Meta-analysis

“…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.…”