Well-Established and Empirically Supported Behavioral Treatments for Migraine

Abstract

This paper provides an overview of the well-established and empirically supported behavioral interventions for the treatment of migraine. The considerable evidence base addressing behavioral interventions amassed since 1969 has conclusively established the efficacy of therapies featuring combinations of relaxation, biofeedback, and stress management training, and demonstrated they are capable of yielding benefits on par with pharmacological therapies for migraine. Behavioral interventions also are well suited for delivery across a variety of different contexts (e.g., group vs. individual, standard clinic vs. limited therapist contact, face-to-face vs. technology-assisted). Despite the amply established efficacy and effectiveness of these self-management interventions for the treatment of migraine, the availability and implementation of these approaches remain limited for many headache sufferers. We anticipate the technological advances in delivery platforms will provide better access to behavioral self-management strategies for migraine.

Biofeedback as Prophylaxis for Pediatric Migraine: A Meta-analysis

“…Our findings are in accordance with the well-established use of behavioral treatment as migraine prophylaxis 36 and with recommendations of biofeedback treatment of migraine in guidelines. 37 Another metaanalysis from 2007 that investigated biofeedback as prophylactic treatment of adults with migraine concluded with a medium effect size.…”

Behavioral management of headache in children and adolescents

“…Consortium [18] noted that, given the presence of specific factors, behavioral and other non-pharmacological treatment are preferred to pharmacological treatment for migraine headache. These factors are:patient preference for non-pharmacological treatments;poor tolerance or poor response to pharmaceuticals;negative side effects of medication;actual or planned pregnancy;history of overuse of acute care medication;significant stress;inadequate ability to cope with stress or pain;comorbid psychological disorders [19]…”

“…Penzien et al report [19] the following recommendations pertaining to behavioral interventions for migraine (as they have been outlined by the US Headache Consortium) [106]: (1) relaxation training, thermal biofeedback combined with relaxation training, electromyographic biofeedback, and cognitive behavioral therapy are treatment options for prevention of migraine (grade A evidence); and (2) behavioral therapy may be combined with preventive drug therapy to achieve added clinical improvement for migraine (grade B evidence).…”

“…Behavioral headache interventions continue to face significant challenges that in part derive from the inability to conduct a truly double blind trial, and from limited availability of behaviourally trained headache clinicians [19, 113]. Rains in his review about the “Behavioral Headache Treatment” [66] has presented a critique of methodological quality of the clinical trials literature, highlighting the strengths and weaknesses in relation to recruitment and selection of patients, sample size and statistical power, the use of a credible control, and the reproducibility of the study interventions in clinical practice.…”

Wireless Surface Electromyography and Skin Temperature Sensors for Biofeedback Treatment of Headache: Validation Study with Stationary Control Equipment (Preprint)

“…Biofeedback, one of several behavioral headache treatments, is well-established and empirically supported [9]. Systematic reviews with meta-analyses demonstrated that biofeedback is effective as a migraine prophylaxis in both the adult and pediatric populations [10,11].…”