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Psychologische Therapie der Migräne

Systematische Übersicht

Psychological therapy of migraine

Systematic review

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Zusammenfassung

Dieses Review fasst zusammen, für welche verhaltenstherapeutischen Behandlungen der Migräne die Wirksamkeit empirisch nachgewiesen werden konnte. Die wichtigsten unimodalen Verfahren sind das thermale und das Elektromyographie(EMG)-Biofeedback-Training sowie die progressive Muskelrelaxation. Die verschiedenen Entspannungstechniken unterscheiden sich in ihrer Wirkung bei Migräne nicht. Im Mittel wird eine Reduktion der Migränehäufigkeit von 35–45 % erreicht. Die mittleren Effektstärken (ES) verschiedener Biofeedback-Techniken hinsichtlich der Schmerzreduktion der Migräne liegen zwischen 0,4 und 0,6. Als multimodales Verfahren kommt das kognitiv-behaviorale Schmerzbewältigungstraining zur Anwendung. Es erzielt im Mittel eine Verbesserung der Migräneaktivität von 39 % und eine ES von 0,54. Alle verhaltenstherapeutischen Einzelverfahren können ergänzend oder alternativ zur medikamentösen Prophylaxe mit vergleichbarem Erfolg eingesetzt werden. Eine Kombination aus pharmakologischer und verhaltenstherapeutischer Behandlung kann einen zusätzlichen Erfolg erzielen. Im Kindes- und Jugendalter finden sich deutliche Evidenzen für eine klinisch relevante Wirksamkeit aller verhaltenstherapeutischen Verfahren. Differenzielle Indikationshinweise gibt es nicht.

Abstract

This review summarizes the various forms of behavioral treatment of migraine which could demonstrate empirical efficacy. The main unimodal kinds of treatment are thermal and electromyography (EMG) biofeedback training and progressive muscle relaxation. The various relaxation techniques do not differ in their efficacy in treating migraine. On average a reduction in migraine frequency of 35-45 % is achieved. The mean effect sizes (ES) of various biofeedback techniques are between 0.4 and 0.6. Cognitive-behavioral treatment is applied as a multimodal treatment and on average achieves an improvement in migraine activity by 39 % and an ES of 0.54. All behavioral procedures can be used in combination or as an alternative to drug prophylaxis with comparable success. A combination of pharmacological and behavioral treatment can achieve additional success. There is strong evidence for the clinically significant efficacy of all forms of behavioral treatment in childhood and adolescence. There are no signs of differential indications.

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Literatur

  1. Allen KD, Shriver MD (1998) Role of parent-mediated pain behavior management strategies in biofeedback treatment of childhood migraines. Behav Ther 29:477–490

    Article  Google Scholar 

  2. Andersson G, Kaldo-Sandström V, Ström L, Strömgren T (2003) Internet administration of the hospital anxiety and depression scale in a sample of tinnitus patients. J Psychosom Res 55:259–262

    Google Scholar 

  3. Andrasik F (2003) Behavioral treatment approaches to chronic headache. J Neurol Sci 24(Suppl 2):S80–S85

    Google Scholar 

  4. Andrasik F (2007) What does the evidence show? Efficacy of behavioural treatments for recurrent headaches in adults. Neurol Sci 28(Suppl 2):S70–S77

    Article  PubMed  Google Scholar 

  5. Andrasik F, Buse CD, Grazzi L (2009) Behavioral medicine for migraine and medication overuse headache. Curr Pain Headache Rep 13:241–248

    Article  PubMed  Google Scholar 

  6. Andrasik F (2010) Biofeedback in headache: An overview of approaches and evidence. Cleve Clin J Med 77:72–76

    Article  Google Scholar 

  7. Andrasik F (2012) Behavioral treatment of headaches: extending the reach. Neurol Sci 33(Suppl 1):127–130

    Article  Google Scholar 

  8. Antonaci F, Dumitrache C, De Cillis I, Allena M (2010) A review of current European treatment guidelines for migraine. J Headache Pain 11:13–19

    Google Scholar 

  9. Attfield M, Peck DF (1979) Temperature self-regulation and relaxation with migraine patients and normals. Behav Res Ther 17:591–595

    Article  PubMed  CAS  Google Scholar 

  10. Bernstein D, Borkovic T (1973) Progressive relaxation training: a manual for the helping profession. Research Press, Champaign

  11. Blanchard EB, Andrasik F, Neff DF et al (1982) Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or, the machines may be necessary some of the time. Behav Res Ther 20:469–481

    Article  PubMed  CAS  Google Scholar 

  12. Blanchard EB, Andrasik F, Silver BV (1980) Biofeedback and relaxation in the treatment of tension headaches: a reply to Belar. J Behav Med 3:227–232

    Google Scholar 

  13. Blanchard EB, Theobald DE, Williamson DA et al (1978) Temperature biofeedback in the treatment of migraine headaches: a controlled evaluation. Arch Gen Psychiatry 35:581–588

    Article  PubMed  CAS  Google Scholar 

  14. Blanchard EB, Andrasik F, Guarnieri P et al (1987) Two-, three, and four-year follow-up on the self-regulatory treatment of chronic headache. J Consult Clin Psychol 55:257–259

    Google Scholar 

  15. Burke EJ, Andrasik F (1989) Home- vs. clinical-based biofeedback treatment for pediatric migraine: results of treatment through one-year follow-up. Headache 29:434–440

    Article  PubMed  CAS  Google Scholar 

  16. Buse DC, Andrasik F (2009) Behavioral medicine for migraine. Neurol Clin 27:445–465

    Article  PubMed  Google Scholar 

  17. Campbell JK, Penzien DB, Wall EM (2000) Evidence-based guidelines for migraine headaches: behavioral and physical treatments. American Academy of Neurology website. http://www.aan.com/professionals/practice/pdfs/gl0089.pdf

  18. Connelly M, Rapoff MA, Thompson N, Connelly W (2006) Headstrong: a pilot study of a CD-ROM intervention for recurrent pediatric headache. J Pediatr Psychol 31:737–747

    Google Scholar 

  19. Cuijpers P, Straten A van, Andersson G (2008) Internet administered cognitive behavior therapy for health problems: a systematic review. J Behav Med 31:169–177

    Google Scholar 

  20. Daly EJ, Donn PA, Galliher MJ, Zimmerman JS (1983) Biofeedback applications to migraine and tension headaches: a double-blinded outcome study. Biofeedback Self Regul 8:135–152

    Article  PubMed  CAS  Google Scholar 

  21. Denecke H, Kröner-Herwig B (2000) Kopfschmerztherapie mit Kindern und Jugendlichen. Hogrefe, Göttingen

  22. Devineni T, Blanchard EB (2005) A randomized controlled trial of an internet-based treatment for chronic headache. Behav Res Ther 43:277–292

    Article  PubMed  Google Scholar 

  23. Diener HC, Weimar C (2013) Leitlinien für Diagnostik und Therapie in der Neurologie. Thieme, Stuttgart, S 688–718

  24. Diener HC, Gaul C, Jensen R et al (2011) Integrated headache care. Cephalalgia 31:1039–1047

    Article  PubMed  Google Scholar 

  25. Eccleston C, Palermo TM, Williams AC et al (2009) Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev:1–51

    Google Scholar 

  26. French DJ, Holroyd KA, Pinell C et al (2000) Perceived self-efficacy and headache-related disability. Headache 40:647–656

    Article  PubMed  CAS  Google Scholar 

  27. Frettlöh J, Franz C, Jäkle C et al (1998) Das Manual. In: Basler HD, Kröner-Herwig B (Hrsg) Psychologische Therapie bei Kopf- und Rückenschmerzen. Quintessenz, München

  28. Fritsche G, Frettlöh J, Hüppe M et al (2010) Prevention of medication overuse in patients with migraine. Pain 151:404–413

    Article  PubMed  Google Scholar 

  29. Fritsche G, May A (2011) Migräne. In: Kröner-Herwig B, Frettlöh F, Klinger R, Nilges P (Hrsg) Schmerzpsychotherapie: Grundlagen, Diagnostik, Krankheitsbilder, Behandlung. Springer, Berlin, S 381–403

  30. Gaul C, Brömstrup J, Fritsche G et al (2011) Evaluating integrated headache care: a one-year follow-up observational study in patients treated at the Essen headache centre. BMC Neurol 11:124

    Article  PubMed  Google Scholar 

  31. Gerber WD, Schoenen J (1998) Biobehavioral correlates in migraine: the role of hypersensitivity and information-processing dysfunction. Cephalalgia 18(Suppl 21):5–11

    PubMed  Google Scholar 

  32. Goadsby PJ, Sprenger T (2010) Current practice and future directions in the prevention and acute management of migraine. Lancet Neurol 9:285–298

    Article  PubMed  Google Scholar 

  33. Goslin RE, Gray RN, McCrory DC et al (1999) Behavioral physical treatments for migraine headache. Technical Review 2.2, Prepared for the Agency for Health Care Policy and Research under Contract No. 290-94-2025. (NTIS Accession No. 127946)

  34. Haddock CK, Rowan AB, Andrasik F et al (1997) Home-based behavioral treatments for chronic benign headache: a meta-analysis of controlled trials. Cephalalgia 17:113–118

    Article  PubMed  CAS  Google Scholar 

  35. Hedborg K, Muhr C (2011) Multimodal behavioral treatment of migraine: an internet-administered, randomized, controlled trial. Ups J Med Sci 116:169–186

    Article  PubMed  Google Scholar 

  36. Hicks CL, Baeyer CL von, McGrath PJ (2006) Online psychological treatment for pediatric recurrent pain: a randomized evaluation. J Pediatr Psychol 31:724–736

    Google Scholar 

  37. Holroyd KA, Penzien DB (1990) Pharmacological versus non-pharmacological prophylaxis of recurrent migraine headache: a meta-analytic review of clinical trials. Pain 42:1–13

    Article  PubMed  CAS  Google Scholar 

  38. Holroyd KA, Drew JB (2006) Behavioral approaches to the treatment of migraine. Semin Neurol 26:199–207

    Article  PubMed  Google Scholar 

  39. Holroyd KA, Cottrell CK, O’Donnell FJ et al (2010) Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial. BMJ 341:c4871. DOI 10.1136/bmj.c4871

    Article  PubMed  Google Scholar 

  40. Janssen K, Neutgens J (1986) Autogenic training and progressive relaxation in the treatment of three kinds of headache. Behav Res Ther 24:199–208

    Article  PubMed  CAS  Google Scholar 

  41. Kröner-Herwig B, Mohn U, Pothmann R (1998) Comparison of biofeedback and relaxation in the treatment of pediatric headache and the influence of parent involvement on outcome. Appl Psychophysiol Biofeedback 23:143–157

    Article  PubMed  Google Scholar 

  42. Kröner-Herwig B, Denecke H (2007) Die Behandlung von Kopfschmerz bei Kindern und Jugendlichen: Eine Praxisstudie. Verhaltensther Verhaltensmed 28:373–385

    Google Scholar 

  43. Labbé EL, Williamson DA (1984) Treatment of childhood migraine using autogenic feedback training. J Consult Clin Psychol 52:968–976

    Google Scholar 

  44. Labbé EL, Ward CH (1990) Electromyographic biofeedback with mental imagery and home practice in the treatment of children with muscle-contraction headache. J Dev Behav Pediatr 11:65–68

    Google Scholar 

  45. Larsson B, Melin L (1986) Chronic headaches in adolescents: treatment in a school setting with relaxation training as compared with information – contact and self-registration. Pain 25:325–336

    Article  PubMed  CAS  Google Scholar 

  46. Lemstra M, Stewart B, Olszynski WP (2002) Effectiveness of multidisciplinary intervention in the treatment of migraine: a randomized clinical trial. Headache 42:845–854

    Article  PubMed  Google Scholar 

  47. Lewis KS (2009) Chronic daily headaches in children and adolescents. Semin Pediatr Neurol 16:31–33

    Article  PubMed  Google Scholar 

  48. Lipchik GL, Holroyd KA, Nash JM (2002) Cognitive-behavioral management of recurrent headache disorders: a minimal therapist contact approach. In: Turk DC, Gatchel RS (Hrsg) Psychological approaches to pain management, 2. Aufl. Guilford Press, New York, S 356–389

  49. Lüking M, Martin A (2010) Entspannung, Imagination, Biofeedback und Meditation. In: Kröner-Herwig B, Frettlöh J, Klinger R, Nilges P (Hrsg) Schmerzpsychotherapie, 6. Aufl. Springer, Berlin, S 566–584

  50. Martin PR, Forsyth MR, Reece J (2007) Cognitive-behavioral therapy versus temporal pulse amplitude biofeedback training for recurrent headache. Behav Ther 38:350–363

    Article  PubMed  Google Scholar 

  51. Martin A (2009) Arten der Biofeedbackbehandlung. In: Martin A, Rief W (Hrsg) Wie wirksam ist Biofeedback? Eine therapeutische Methode. Huber, Bern, S 23–28

  52. McGrath PJ, Humphreys P, Goodman JT et al (1988) Relaxation prophylaxis for childhood migraine: a randomized placebo-controlled trial. Dev Med Child Neurol 30:626–631

    Article  PubMed  CAS  Google Scholar 

  53. McGrath PJ, Humphreys P, Keene D et al (1992) The efficacy and efficiency of a self-administered treatment for adolescent migraine. Pain 49:321–324

    Article  PubMed  CAS  Google Scholar 

  54. Merelle SYM, Sorbi MJ, Doornen LJ van, Passchier J (2008) Migraine patients as trainers of their fellow patients in non-pharmacological preventive attack management: short-term effects of a randomized controlled trial. Cephalalgia 28:127–138

    PubMed  CAS  Google Scholar 

  55. Merelle SYM, Sorbi MJ, Doornen LJP van, Passchier J (2008) Lay trainers with migraine for a home-based behavioural training: a 6-month follow-up study. Headache 48:1311–1325

    Article  PubMed  Google Scholar 

  56. Mullally WJ, Hall K, Goldstein R (2009) Efficacy of biofeedback in the treatment of migraine and tension type headache. Pain Physician 12:1005–1011

    PubMed  Google Scholar 

  57. Nestoriuc Y, Martin A (2007) Efficacy of biofeedback for migraine: a meta-analysis. Pain 128:111–127

    Article  PubMed  Google Scholar 

  58. Nestoriuc Y, Martin A, Rief W, Andrasik F (2008) Biofeedback treatment for headache disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback 33:125–140

    Article  PubMed  Google Scholar 

  59. Nicholson RA, Buse DC, Andrasik F, Lipton RB (2011) Nonpharmacologic treatments for migraine and tension-type headache: how to choose and when to use. Curr Treat Options Neurol 13:28–40

    Article  PubMed  Google Scholar 

  60. Olness K (1987) Comparison of self-hypnosis and propanolol in the treatment of juvenile classic migraine. Pediatrics 79:593–597

    PubMed  CAS  Google Scholar 

  61. Palermo TM, Eccleston C, Lewandowski AS et al (2010) Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents: an updated meta-analytic review. Pain 148:387–397

    Article  PubMed  Google Scholar 

  62. Penzien DB, Andrasik F, Freidenberg BM et al (2005) Guidelines for trials of behavioral treatments for recurrent headache, first edition: American Headache Society Behavioral Clinical Trials Workgroup. Headache 45(Suppl 2):S110–S132

    Article  PubMed  Google Scholar 

  63. Rains JC, Penzien DB, McCrory DC, Gray RN (2005) Behavioral headache treatment: history, review of the empirical literature, and methodological critique. Headache 45(Suppl 2):S92–S109

    Article  PubMed  Google Scholar 

  64. Rief W, Birbaumer N (2000) Biofeedback – ein Weg zur Beeinflussung von Körperfunktionen. In: Rief W, Birbaumer N (Hrsg) Biofeedback-Therapie. Schattauer, Stuttgart, S 1–6

  65. Rothrock JF, Parada VA, Sims C et al (2006) The impact of intensive patient education on clinical outcome in a clinic-based migraine population. Headache 46:726–731

    Article  PubMed  Google Scholar 

  66. Sauro KM, Becker WJ (2009) The stress and migraine interaction. Headache 49:1378–1386

    Article  PubMed  Google Scholar 

  67. Sartory G, Müller B, Pothmann R (1998) A comparison of psychological and pharmacological treatment of pediatric migraine. Behav Res Ther 36:1155–1170

    Article  PubMed  CAS  Google Scholar 

  68. Scharff L, Marcus DA (1994) Interdisciplinary outpatient group treatment of intractable headache. Headache 34:73–78

    Article  PubMed  CAS  Google Scholar 

  69. Seng EK, Holroyd KA (2010) Dynamics of changes in self-efficacy and locus of control expectancies in the behavioral and drug treatment of severe migraine. Ann Behav Med 40:235–247

    Article  PubMed  Google Scholar 

  70. Seng EK, Holroyd KA (2012) Psychiatric comorbidity and response to preventative therapy in the treatment of severe migraine trial. Cephalalgia 32:390–400

    Article  PubMed  Google Scholar 

  71. Silver BV, Blanchard EB, Williamson DA et al (1979) Temperature biofeedback and relaxation training in the treatment of migraine headaches. Biofeedback Self Regul 4:359–366

    Article  PubMed  CAS  Google Scholar 

  72. Silberstein SD (2000) Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology. Neurology 55:754–762

    Article  PubMed  CAS  Google Scholar 

  73. Smitherman TA, Maizels M, Penzien DB (2008) Headache chronification: screening and behavioral management of comorbid depressive and anxiety disorders. Headache 48:45–50

    Article  PubMed  Google Scholar 

  74. Sorbi MJ, Mak SB, Houtveen J et al (2007) Mobile web-based monitoring and coaching: feasibility in chronic migraine. J Med Internet Res 9:e38

    Google Scholar 

  75. Ström L, Pettersson R, Andersson G (2000) A controlled trial of self-help treatment of recurrent headache conducted via the Internet. J Consult Clin Psychol 68:722–727

    Google Scholar 

  76. Thoden U, Haag G, Weinzierl R, Niederberger U (1989) Betablocker versus Psychotherapie in der Migräneprophylaxe. Therapiewoche Neurologie/Psychiatrie 3:35–38

  77. Thorn BE, Pence LB, Ward LC et al (2007) A randomized clinical trial of targeted cognitive behavioral treatment to reduce catastrophizing in chronic headache sufferers. J Pain 8:938–949

    Google Scholar 

  78. Tracey I, Ploghaus A, Gati JS et al (2002) Imaging attentional modulation of pain in the periaqueductal gray in humans. J Neurosci 22:2748–2752

    Google Scholar 

  79. Trautmann E, Kröner-Herwig B (2010) A randomized controlled trial of internet-based self-help training for recurrent headache in childhood and adolescence. Behav Res Ther 48:28–37

    Article  PubMed  Google Scholar 

  80. Trautmann E, Lackschewitz H, Kröner-Herwig B (2006) Psychological treatment of recurrent headache in children and adolescents – a meta-analysis. Cephalalgia 26:1411–1426

    Article  PubMed  CAS  Google Scholar 

  81. Victor TW, Hu X, Campbell J et al (2010) Association between migraine, anxiety and depression. Cephalalgia 30:567–575

    Article  PubMed  CAS  Google Scholar 

  82. Wallasch TM, Angeli A, Kropp P (2012) Outcomes of a headache-specific cross-sectional multidisciplinary treatment program. Headache. DOI 10.1111/j.1526-4610.2012.02189.x

  83. Wicksell RK, Melin L, Lekander M, Olsson GL (2009) Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain – a randomized controlled trial. Pain 141:248–257

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neurologische Klinik, Universität Essen, Hufelandstr. 55, 45122, Essen, Deutschland

    G. Fritsche

  2. Klinische Psychologie und Psychotherapie, Universität Göttingen, Göttingen, Deutschland

    B. Kröner-Herwig

  3. Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Rostock, Rostock, Deutschland

    P. Kropp

  4. Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    U. Niederberger

  5. Michael-Balint-Klinik, Königsfeld, Deutschland

    G. Haag

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  1. G. Fritsche
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  4. U. Niederberger
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Anmerkung: Die Arbeit weist Überschneidungen zur publizierten Leitlinie „Therapie der Migräne“ auf [Therapie der Migräne. In: Diener HC, Weimar W (2013) Leitlinien für Diagnostik und Therapie in der Neurologie. Thieme, Stuttgart, S 688–718].

Auszüge der hier berichteten Evidenzen und ausgesprochenen Empfehlungen sind Bestandteil des psychologischen Teils der S2k-Leitlinie „Therapie der Migräne“ der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF).

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Fritsche, G., Kröner-Herwig, B., Kropp, P. et al. Psychologische Therapie der Migräne. Schmerz 27, 263–274 (2013). https://doi.org/10.1007/s00482-013-1319-9

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