Effectiveness of Patient Education and Cognitive Behavioural Treatment as a Non-Pharmacological Intervention for Migraine in Adults – a Systematic Review

Abstract

To evaluate the content of patient education and cognitive behavioural therapy and its effectiveness in the prevention of migraine for adults, a systematic search was conducted in the databases MEDLINE, EMBASE, PsycINFO and CINAHL. RCTs published in the past 10 years in German or English, reporting on any form of patient education or cognitive behavioural therapy for adult migraineurs, were included. Two reviewers independently searched and evaluated search results. The methodological quality of selected studies was assessed using the Cochrane risk of bias tool 2.0 independently by two reviewers. Data on content and effectiveness were extracted in a predesigned table. Across 1059 records, 14 studies were eligible, including 2266 participants (82,7% females). Contents of patient education included explanations on the link between thoughts and feelings, information on lifestyle influences on headaches, relaxation techniques and stress management, advice on diet and the benefit of physical activity. In addition, patient education focussed on the pathogenesis and diagnostic criteria of migraine, triggering factors and effective acute or prophylactic drug use. Outcome measures included headache frequency, medication intake, function and disability, as well as psychosocial status. Education reduced migraine frequency and improved quality of life. Effect sizes were small, and contents were heterogeneous. Educational and behavioural approaches can positively influence headache frequency. However, the content, duration and frequency and education formats varied widely. The level of evidence for education and cognitive behavioural therapy as a non-pharmacological intervention for migraine is still low. The protocol for the systematic review was registered in the database PROSPERO (PROSPERO 2019 CRD42019134463) prior to the data collection.

Does the Intensity of the Headache Differ According to the Level of Neck Disability in Chronic Migraine Patients?

“…In light of the results of the literature studies and our findings, we think that evaluation and treatment methods may need to be shaped differently. In addition to drug therapy, patients can be given patient and pain education [ 34 ], a biopsychosocial model can be applied [ 35 ] or physical therapy and rehabilitation practices can be recommended [ 36 ]. Rezaeian et al evaluated migraine patients in two groups as treatment and control groups and used myofascial release and stretching methods in the treatment group.…”

Physiotherapie bei Kopfschmerzen vom Spannungstyp und Migräne

“…In der Physiotherapie findet ein weitreichendes Spektrum edukativer Maßnahmen statt, die von Heimübungen über ergonomische Maßnahmen bis hin zu neurophysiologischen Erläuterungen zum Krankheitsbild reichen können. Welche Art der Edukation bei Kopfschmerzen wirksam sein soll, wird jedoch nicht näher beschrieben [41], auch wenn häufiger von Lifestyle-Maßnahmen gesprochen wird. Diese umfassen für beide Kopfschmerzarten eine Lebensführung mit regelmäßigem Schlaf-Wach-Rhythmus, regelmäßigen Mahlzeiten und Flüssigkeitszufuhr, regelmäßige Pausen und Entspannungsübungen sowie Stressmanagement [42].…”

Conceptualising migraine attacks from a biopsychosocial model using qualitative and functional behavioural analysis

“…Cognitive behaviour therapy (CBT) for migraine involves different techniques, such as stress management, relaxation and cognitive strategies [ 12 , 21–23 ]. Finally, the role of cognitive-behavioural therapy integrated with pharmacological should be further stressed [ 24 ]. Participants who underwent CBT for migraine experienced that a non-pharmacological treatment option was positive and desirable [ 25 ].…”

“…A recent systematic review showed that the level of evidence for education and cognitive behavioural therapy for migraine remains yet low [ 10 , 12 ]. Educational and behavioural approaches can positively influence headache frequency and improved quality of life however, the content, duration and frequency and education formats varied widely [ 24 ]. Identifying behavioural and psychological factors associated with migraine in individuals without psychiatric comorbidities is important to improve the management of migraine through non-pharmacological strategies [ 15 ].…”