Well-Established and Empirically Supported Behavioral Treatments for Migraine
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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.
KeywordsMigraine Self-management Behavioral treatment Relaxation training Biofeedback Cognitive behavioral therapy Stress management training
Compliance with Ethics Guidelines
Conflict of Interest
Donald B. Penzien reports grants from Merck and Co., Inc.
Megan B. Irby declares no potential conflicts of interest.
Todd A. Smitherman receives research support from Merck.
Jeanetta C. Rains reports National Institute of Health R21, Sleep Regulation and Circadian Phase in Chronic Migraine Position: Consultant (principal investigator: Jason Ong, PhD, Rush University) (2013–2015).
Timothy T. Houle reports grants from Merck and Co., Inc.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 3.Committee on Quality of Healthcare in America. Crossing the quality chasm: a new health system for the 21st century. Summary. Heal. San Fr. 2001;1–358.Google Scholar
- 8.Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW, Bandura A, Gonzalez VM, Laurent DD, and Holman HR. Chronic disease self-management program: 2-year health status and health care utilization outcomes. 2001.Google Scholar
- 11.Popa-Velea O, Duma A. Psychological factors influencing therapeutic adherence in asthma. Cogniţie Creier Comport Spec Issue Heal Cent East Eur Context Transit Psychosoc Perspect. 2006;10(1):113–31.Google Scholar
- 12.Li R, Shrestha SS, Lipman R, Burrows NR, Kolb LE, Rutledge S. Diabetes self-management education and training among privately insured persons with newly diagnosed diabetes—Unites States, 2011–2012. Morb Mortal Wkly Rep. 2014;63(46):1045–9.Google Scholar
- 14.Von Korff M, Moore JE, Lorig K, Cherkin DC, Saunders K, González VM, Laurent D, Rutter C, and Comite F. A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care. 1998.Google Scholar
- 15.Moore JE, Von Korff M, Cherkin D, Saunders K, Lorig K. A randomized trial of a cognitive behavioral program for enhancing back pain self care in a primary care setting. Pain. 2000;88:145–53.Google Scholar
- 17.Smitherman TA, Penzien DB, Rains JC, Nicholson RA, Houle TT. Headache: advances in psychotherapy—evidence-based practice. Boston, Massachusetts: Hogrere and Huber; 2015.Google Scholar
- 18.Penzien DB, Maizels M, and Rains JC. Management of headache pain. Behav Psychopharmacol Ther Pain Manag. 2011;349–364.Google Scholar
- 19.Campbell JK, Penzien DB, Wall EM. Evidenced-based guidelines for migraine headache: behavioral and physical treatments. US Headache Consort. 2010;1:1–29.Google Scholar
- 20.Bernstein DA, Borkovec TD, Hazlett-Stevens H. New directions in progressive relaxation training: a guidebook for helping professionals. Westport: Greenwood Publishing Group; 2000.Google Scholar
- 22.Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral headache treatment: history, review of the empirical literature, and methodological critique. Headache. 2005;45:S91–S108.Google Scholar
- 23.Haddock CK, Rowan AB, Andrasik F, Wilson PG, Talcott GW, Stein RJ. Home-based behavioral treatments for chronic benign headache: a meta-analysis of controlled trials. Cephalalgia. 1997;17:113–8.Google Scholar
- 24.Mérelle SY, Sorbi MJ, Passchier J. The preliminary effectiveness of migrainelay trainers in a home-based behavioural management training. Patient Educ Couns. 2006;61(2):307–11.Google Scholar
- 27.Kohlenberg RJ, Kahn T. Self-help treatment for migraine headaches: a controlled outcome study. Headache. 1981;21:196–200.Google Scholar
- 28.Heapy AA, Higgins DM, Cervone D, Wandner L, Fenton B, and Kerns RD. A systematic review of technology-assisted self-management interventions for chronic pain: looking across treatment modalities. Clin J Pain. 2014;epub ahead.Google Scholar
- 29.Hedborg K, Muhr C. Multimodal behavioral treatment of migraine: an Internet-administered, randomized, controlled trial. Ups J Med Sci. 2011;116:169–86.Google Scholar
- 30.Hedborg K, Muhr C. The influence of multimodal behavioral treatment on the consumption of acute migraine drugs: a randomized, controlled study. Cephalalgia. 2012;32(4):297–307.Google Scholar
- 31.Kleiboer A, Sorbi MJ, van Silfhout M, Kooistra L, Passchier J. Short-term effectiveness of an online behavioral training in migraine self-management: a randomized controlled trial. Behav Res Ther. 2014;61:61–9.Google Scholar
- 32.Sorbi MJ, Kleiboer A, Van Silfhout M, Vink G, and Passchier J. Medium-term effectiveness of online behavioral training in migraine self-management. Cephalalgia. 2014;epub ahead.Google Scholar
- 33.Donovan E, Mehringer S, Zeltser LK. Assessing the feasibility of a Web-based self-management program for adolescents with migraines and their caregivers. Clin Pediatr (Phila). 2013;52(7):667–70.Google Scholar
- 34.Heyer GL, Perkins SQ, Rose SC, Aylward SC, Lee JM. Comparing patient and parent recall of 90 days and 30 days migraine disability using elements of the PedMIDAS and an Internet headache diary. Cephalalgia. 2014;34:298–306Google Scholar
- 35.Trautmann E, Kröner-Herwig B. A randomized controlled trial of Internet-based self-help training for recurrent headache in childhood and adolescence. Behav Res Ther. 2010;48:28–37.Google Scholar
- 36.Budzynski TH, Stoyva JM. An instrument for producing deep muscle relaxation by means of analog information feedback. J Appl Behav Anal. 1969;2:231–7.Google Scholar
- 37.Budzynski T, Stoyva J, Adler C. Feedback-induced muscle relaxation: application to tension headache. J Behav Ther Exp Psychiatry. 1970;1:205–11.Google Scholar
- 38.Goslin RE, Gray RN, McCrory DC, Penzien DB, Rains JC and Hasselblad V. Behavioral and physical treatments for migraine headache. Tech Rev. 2.2. 1999.Google Scholar
- 39.Nestoriuc Y, Martin A. Efficacy of biofeedback for migraine: a meta-analysis. Pain. 2007;128:111–27.Google Scholar
- 40.Silberstein SD. 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. 2000;55(6):754–62.Google Scholar
- 41.••Holroyd KA, Cottrell CK, O’Donnell FJ, Cordingley GE, Drew JB, Carlson BW, et al. Effect of preventive (beta blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial. BMJ. 2010;341:c4871. A well designed and executed clinical trial examining separate and additive effects of pharmacologic and non-pharmacologic therapies for migraine.Google Scholar
- 42.Holroyd KA, O’Donnell FJ, Stensland M, Lipchik GL, Cordingley GE and Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. 2001.Google Scholar
- 43.••Powers SW, Kashikar-Zuck SM, Allen JR, LeCates SL, Slater SK, Zafar M, et al. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA. 2013;310:2622–30. State of the art trial addressing behavioral versus pharmacologic therapy for pediatric migraine.Google Scholar
- 44.Holroyd KA, Nash JM, Pingel JD, Cordingley GE, and Jerome A. A comparison of pharmacological (amitriptyline HCL) and nonpharmacological (cognitive-behavioral) therapies for chronic tension headaches. 1991.Google Scholar
- 45.Holroyd KA, Penzien DB. Pharmacological versus non-pharmacological prophylaxis of recurrent migraine headache: a meta-analytic review of clinical trials. Pain. 1990;42:1–13.Google Scholar
- 46.Holroyd KA, Penzien DB, and Cordingley GE. Propranolol in the management of recurrent migraine: a meta-analytic review. 1991.Google Scholar
- 47.Penzien DB, Andrasik F, Freidenberg BM, Houle TT, Lake AE, Lipchik GL, et al. Guidelines for trials of behavioral treatments for recurrent headache, first edition: American Headache Society Behavioral Clinical Trials Workgroup. Headache. 2005;45:S109–31.Google Scholar
- 48.Rains JC, Penzien DB. Behavioral research and the double-blind placebo-controlled methodology: challenges in applying the biomedical standard to behavioral headache research. Headache. 2005;45:479–86.Google Scholar
- 49.Penzien DB, Irby MB. Insights on treatment mechanisms of cognitive-behavioral migraine therapy. Headache. 2014;54(9):1439–40.Google Scholar
- 50.Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2163–96.Google Scholar