Systematic review of cognitive behavioural therapy for the management of headaches and migraines in adults

Abstract

Aim: This systematic review aimed to establish if cognitive behavioural therapy (CBT) can reduce the physical symptoms of chronic headache and migraines in adults. Methods: Evidence from searches of eight databases was systematically sought, appraised and synthesised. Screening of title and abstracts was conducted independently by two reviewers. Full papers were screened, data extracted and quality assessed by one reviewer and checked by a second. Data were synthesised narratively by intervention due to the heterogeneity of the studies. The inclusion criteria specified randomised controlled trials with CBT as an intervention in adults suffering from chronic headaches/ migraines not associated with an underlying pathology/medication overuse. CBT was judged on the basis of authors describing the intervention as CBT. The diagnosis of the condition had to be clinician verified. Studies had to include a comparator and employ headache/migraine-specific outcomes such as patientreported headache days. Results: Out of 1126 screened titles and abstracts and 20 assessed full papers, 10 studies met the inclusion criteria of the review. Some studies combined CBT with another intervention, as well as employing varying numbers of comparators. CBT was statistically significantly more effective in improving some headachesrelated outcomes in CBT comparisons with waiting lists (three studies), in combination with relaxation compared with relaxation only (three studies) or antidepressant medication (one study), with no statistically significant differences in three studies. Conclusions:The findings of this review were mixed, with some studies providing evidence in support of the suggestion that people experiencing headaches or migraines can benefit from CBT, and that CBT can reduce the physical symptoms of headache and migraines. However, methodology inadequacies in the evidence base make it difficult to draw any meaningful conclusions or to make any recommendations. Keywords British Journal of Pain 9(4)Headaches are thought to occur regularly in around 46% and migraine in 11% of the population, making it one of the most common neurological problems presented to general practitioners (GPs) and neurologists in the United Kingdom. 1 A primary care-based study set in 18 general practices in the south Thames region of England (urban and rural areas) based on 141,100 patients (aged 18 to 75 years) interviewed people reporting problematic experiences of headache in order to establish healthcare use and the cost associated with the provision of services to people with headaches. Extrapolating to the UK population, the authors suggest the total annual cost of migraines and headaches in 2011 was around £4.8 billion (including lost employment), with around £956 million due to healthcare use. 2 The authors propose that these figures may be underestimations, as most headaches are self-managed 3 and so not reported to GPs. This is supported by other significant organisations 4,5 and demonstrates the magnitude of the problem of headache...

The American Headache Society Position Statement On Integrating New Migraine Treatments Into Clinical Practice

“…Biobehavioral therapy, including cognitive behavioral therapy (CBT) and biofeedback, and relaxation therapies have been shown to be effective in the acute and preventive treatment of migraine and have Grade A evidence for their use preventively. [81][82][83][84][85] Biobehavioral therapies may be used alone or in conjunction with pharmacologic and interventional treatments. Evidence suggests that combining biobehavioral interventions with pharmacotherapy provides greater benefits than either modality alone.…”

“…Evidence suggests that combining biobehavioral interventions with pharmacotherapy provides greater benefits than either modality alone. 82,83,86…”

“…Evidence suggests that combining biobehavioral interventions with pharmacotherapy provides greater benefits than either modality alone 82,83,86. Evidence suggests that combining biobehavioral interventions with pharmacotherapy provides greater benefits than either modality alone 82,83,86.…”

Cognitive behavioral therapy improves adherence to antiretroviral therapy in HIV-infected patients: a prospective randomized controlled trial from eastern India

“…migraine, heart failure, etc.) [19,20]. Use of CBT can dispel misconceptions and individual cognitive errors about the continuation of ART among HIV patients and thus can help in increasing the adherence to therapy in them.…”

Therapie der Migräneattacke und Prophylaxe der Migräne

“…Neuere Übersichtsarbeiten weisen auch auf eine große Heterogenität der Studien und kleinere Effektstärken hin und führen methodische Einschränkungen (z. B. kleine Gruppen, fehlende Randomisierung) an (447).…”