Skip to main content
SpringerLink
Log in

Behavioral Treatment of Migraine in Children and Adolescents

  • Leading Article
  • Published:
Pediatric Drugs Aims and scope Submit manuscript

Abstract

Behavioral interventions, particularly biofeedback and relaxation therapy, have demonstrated their effectiveness in the treatment of both adults and older children with migraine in controlled trials. The physiological basis for their effectiveness is unclear, but data from one trial suggest that levels of plasma β-endorphin can be altered by relaxation and biofeedback therapies. The data supporting the effectiveness of behavioral therapies are less clear-cut in children than in adults, but that is also true for the data supporting medical treatment. This is due in part to methodological issues, especially the lack of a specific test for migraine, which has hampered research and helped lead to an inappropriate de-emphasis on care for childhood headache. In addition, migraine headaches in children are often briefer and have a higher rate of spontaneous remission than those experienced by adults, making it difficult to separate effective from ineffective treatments.

While it is widely believed that stress is a major factor in childhood migraine, well-designed studies have had difficulty developing data to support this viewpoint. Many clinicians utilize ‘confident reassurance’, reassuring the family that the child is not seriously ill, in the belief that having migraine headaches can be stressful. They also modify behaviors that are believed to trigger migraine headaches, such as poor sleep habits or irregular meal times.

Relaxation therapies use techniques such as progressive relaxation, self-hypnosis, and guided imagery. Several studies have found relaxation therapies to be as effective, or more effective, in reducing the frequency of migraine headaches than modest doses of a β-blockade medication, although one study found relaxation therapy to be no more effective than a control program. Several studies have demonstrated that these therapies can be taught to children in a low cost but effective manner.

Biofeedback therapies commonly use an apparatus to demonstrate a physiological effect. Most commonly in pediatrics, children are taught to raise the temperature of one of their fingers. This can be done with or without a thermometer. Several groups have shown that these techniques can be taught to children and that their use is associated with fewer and briefer migraine headaches.

People who experience migraines can also experience episodic headaches throughout life. An important consideration is preparing children to deal with future headaches, allowing them to feel in control of their health. Behavioral therapies have the potential to do this, giving the child access to a technique that can be easily resumed without a medical visit or prescription.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bille B. Migraine in school children. Acta Paediatr 1962; 51: 1–51

    Article  Google Scholar 

  2. Sillanpaa M, Anttila P. Increasing prevalence of headache in 7-year-old school children. Headache 1996; 36(8): 466–70

    Article  PubMed  CAS  Google Scholar 

  3. Stang PE, Osterhaus JT. Impact of migraine in the United States: data from the national health interview survey. Headache 1993; 33: 29–35

    Article  PubMed  CAS  Google Scholar 

  4. Holden EW, Deichmann MM, Levy JD. Empirically supported treatments in pediatric psychology: recurrent pediatric headache. J Pediatr Psychol 1999; 24(2): 91–109

    Article  PubMed  CAS  Google Scholar 

  5. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Cephalalgia 1998; 8Suppl. 7: 1–96

    Google Scholar 

  6. Metsahonkala L, Sillanpaa M. Migraine in children: an evaluation of the IHS criteria. Cephalalgia 1994; 14(4): 285–90

    Article  PubMed  CAS  Google Scholar 

  7. Leviton A, Slack WV, Bana D, et al. Age-related headache characteristics. Arch Neurol 1984; 41(7): 762–4

    Article  PubMed  CAS  Google Scholar 

  8. Winner P, Wasiewski W, Gladstein J, et al. Multicenter prospective evaluation of proposed pediatric migraine revisions to the IHS criteria. Pediatric Headache Committee of the American Association for the Study of Headache. Headache 1997; 37(9): 545–8

    Article  PubMed  CAS  Google Scholar 

  9. Wittrock DA, Ficek SK, Cook TM. Headache-free controls: evidence of headaches in individuals who deny having headaches during diagnostic screening. Headache 1996; 36(7): 416–8

    Article  PubMed  CAS  Google Scholar 

  10. Hermann C, Kim M, Blanchard EB. Behavioral and prophylactic pharmacological intervention studies of pediatric migraine: an exploratory meta-analysis. Pain 1995; 60(3): 239–55

    Article  PubMed  CAS  Google Scholar 

  11. Reid GJ, McGrath PJ. Psychological treatments for migraine. Biomed Pharmacother 1996; 50(2): 58–63

    Article  PubMed  CAS  Google Scholar 

  12. Passchier J, Orlebeke JF. Headaches and stress in school children: an epidemiological study. Cephalalgia 1985; 5(3): 167–76

    Article  PubMed  CAS  Google Scholar 

  13. Metsahonkala L, Sillanpaa M, Tuominen J. Social environment and headache in 8- to 9-year-old children: a follow- up study. Headache 1998; 38(3): 222–8

    Article  PubMed  CAS  Google Scholar 

  14. Passchier J. A critical note on psychophysiological stress research into migraine patients. Cephalalgia 1994; 14(3): 194–8

    Article  PubMed  CAS  Google Scholar 

  15. McGrath PJ. Clinical psychology issues in migraine headaches. Can J Neurol Sci 1999; 26Suppl. 3: S33–6

    PubMed  Google Scholar 

  16. Cooper PJ, Bawden HN, Camfield PR, et al. Anxiety and life events in childhood migraine. Pediatrics 1987; 79(6): 999–1004

    PubMed  CAS  Google Scholar 

  17. Anttila P, Metsahonkala L, Helenius H, et al. Predisposing and provoking factors in childhood headache. Headache 2000; 40(5): 351–6

    Article  PubMed  CAS  Google Scholar 

  18. Metsahonkala L, Sillanpaa M, Tuominen J. Social environment and headache. Headache 1998; 38(3): 222–8

    Article  PubMed  CAS  Google Scholar 

  19. Larsson B. The role of psychological, health-behaviour and medical factors in adolescent headache. Dev Med Child Neurol 1988; 30(5): 616–25

    Article  PubMed  CAS  Google Scholar 

  20. Andrasik F, Kabela E, Quinn S, et al. Psychological functioning of children who have recurrent migraine. Pain 1988; 34(1): 43–52

    Article  PubMed  CAS  Google Scholar 

  21. Lewis DW, Middlebrook MT, Mehallick L, et al. Pediatric headaches: what do the children want. Headache 1996; 36(4): 224–30

    Article  PubMed  CAS  Google Scholar 

  22. McGrath PJ, Reid GJ. Behavioral treatment of pediatric headache. Pediatr Ann 1995; 24(9): 486–91

    PubMed  CAS  Google Scholar 

  23. Lewis DW, Lake AEI. Psychological and nonpharmacologic treatment of headache. In: Winner P, Rothner AD, editors. Headache in children and adolescents. London: BC Decker, 2001: 126–41

    Google Scholar 

  24. Fenichel GM. Clinical pediatric neurology: a signs and symptoms approach. 4th ed. Philadelphia (PA): WB Saunders Company, 2001

    Google Scholar 

  25. Prensky AL, Sommer D. Diagnosis and treatment of migraine in children. Neurology 1979; 29(4): 506–10

    Article  PubMed  CAS  Google Scholar 

  26. Holroyd KA, Penzien DB. Psychosocial interventions in the management of recurrent headache disorders (1): overview and effectiveness. Behav Med 1994; 20(2): 53–63

    Article  PubMed  CAS  Google Scholar 

  27. Metsahonkala L, Sillanpaa M, Tuominen J. Headache diary in the diagnosis of childhood migraine. Headache 1997; 37(4): 240–4

    Article  PubMed  CAS  Google Scholar 

  28. Bakal DA, Demjen S, Kaganov JA. Cognitive behavioral treatment of chronic headache. Headache 1981; 21(3): 81–6

    Article  PubMed  CAS  Google Scholar 

  29. Holroyd KA, Andrasik F. Coping and the self-control of chronic tension headache. J Consult Clin Psychol 1978; 46(5): 1036–45

    Article  PubMed  CAS  Google Scholar 

  30. Richter IL, McGrath PJ, Humphreys PJ, et al. Cognitive and relaxation treatment of paediatric migraine. Pain 1986; 25(2): 195–203

    Article  PubMed  CAS  Google Scholar 

  31. Bruni O, Fabrizi P, Ottaviano S, et al. Prevalence of sleep disorders in childhood and adolescence with headache: a case-control study. Cephalalgia 1997; 17(4): 492–8

    Article  PubMed  CAS  Google Scholar 

  32. Robbins L. Precipitating factors in migraine: a retrospective review of 494 patients. Headache 1994; 34(4): 214–6

    Article  PubMed  CAS  Google Scholar 

  33. Blau JN, Thavapalan M. Preventing migraine: a study of precipitating factors. Headache 1988; 28(7): 481–3

    Article  PubMed  CAS  Google Scholar 

  34. Leviton A, Slack WV, Masek B, et al. A computerized behavioral assessment for children with headaches. Headache 1984; 24(2): 182–5

    Article  PubMed  CAS  Google Scholar 

  35. Salfield SA, Wardley BL, Houlsby WT, et al. Controlled study of exclusion of dietary vasoactive amines in migraine. Arch Dis Child 1987; 62(5): 458–60

    Article  PubMed  CAS  Google Scholar 

  36. Marcus DA, Scharff L, Turk D, et al. A double-blind provocative study of chocolate as a trigger of headache. Cephalalgia 1997; 17(8): 855–62

    Article  PubMed  CAS  Google Scholar 

  37. Budd KS, Kedesdy JH. Investigation of environmental factors in pediatric headache. Headache 1989; 29(9): 569–73

    Article  PubMed  CAS  Google Scholar 

  38. Silberstein SD, Saper JR, Freitag FG. Migraine: diagnosis and treatment. In: Silberstein SD, Lipton R, Dalessio DJ, editors. Wolff’s headache and other head pain. Oxford: Oxford University Press, 2001: 121–237

    Google Scholar 

  39. Bruni O, Galli F, Guidetti V. Sleep hygiene and migraine in children and adolescents. Cephalalgia 1999; 19Suppl. 25: 57–9

    PubMed  Google Scholar 

  40. Winner P, Linder S, Wasiewski W. Pharmacologic treatment of headache. In: Winner P, Rothner AD, editors. Headache in children and adolescents. London: BC Decker, 2001: 87–115

    Google Scholar 

  41. McGrath PJ, Humphreys P, Keene D, et al. The efficacy and efficiency of a self-administered treatment for adolescent migraine. Pain 1992; 49(3): 321–4

    Article  PubMed  CAS  Google Scholar 

  42. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. JAMA 1996; 276(4): 313–8

    Article  Google Scholar 

  43. Penzien DB, Holroyd KA. Psychosocial interventions in the management of recurrent headache disorders (2): description of treatment techniques. Behav Med 1994; 20(2): 64–73

    Article  PubMed  CAS  Google Scholar 

  44. Evers S. Drug treatment of migraine in children: a comparative review. Paediatr Drugs 1999; 1(1): 7–18

    Article  PubMed  CAS  Google Scholar 

  45. Carroll JD, Reidy M, Savundra PA, et al. Long-acting propranolol in the prophylaxis of migraine: a comparative study of two doses. Cephalalgia 1990; 10(2): 101–5

    Article  PubMed  CAS  Google Scholar 

  46. Pradalier A, Serratrice G, Collard M, et al. Long-acting propranolol in migraine prophylaxis: results of a double-blind, placebo-controlled study. Cephalalgia 1989; 9(4): 247–53

    PubMed  CAS  Google Scholar 

  47. Olness K, MacDonald JT, Uden DL. Comparison of self-hypnosis and propranolol in the treatment of juvenile classic migraine. Pediatrics 1987; 79(4): 593–7

    PubMed  CAS  Google Scholar 

  48. Sartory G, Muller B, Metsch J, et al. A comparison of psychological and pharmacological treatment of pediatric migraine. Behav Res Ther 1998; 36(12): 1155–70

    Article  PubMed  CAS  Google Scholar 

  49. McGrath PJ, Cunningham SJ, Lascelles MA, et al. A treatment for migraine headaches: patient manual and audiotape. Ottawa (ON): University of Ottawa Press, 1990

    Google Scholar 

  50. McGrath PJ, Cunningham SJ, Lascelles MA, et al. A treatment for migraine headaches: professional handbook. Ottawa (ON): University of Ottawa Press, 1990

    Google Scholar 

  51. McGrath PJ, Humphreys P, Goodman JT, et al. Relaxation prophylaxis for childhood migraine: a randomized placebo-controlled trial. Dev Med Child Neurol 1988; 30(5): 626–31

    Article  PubMed  CAS  Google Scholar 

  52. Labbe EE, Williamson DA. Treatment of childhood migraine using autogenic feedback training. J Consult Clin Psychol 1984; 52: 968–76

    Article  PubMed  CAS  Google Scholar 

  53. Labbe EE. Treatment of childhood migraine with autogenic training and skin temperature biofeedback: a component analysis. Headache 1995; 35(1): 10–3

    Article  PubMed  CAS  Google Scholar 

  54. Burke EJ, Andrasik F. Home vs clinic-based biofeedback treatment for pediatric migraine: results of treatment through one-year follow-up. Headache 1989; 29(7): 434–40

    Article  PubMed  CAS  Google Scholar 

  55. Guarnieri P, Blanchard EB. Evaluation of home-based thermal biofeedback treatment of pediatric migraine headache. Biofeedback Self Regul 1990; 15(2): 179–84

    Article  PubMed  CAS  Google Scholar 

  56. Powers SW, Mitchell MJ, Byars KC, et al. A pilot study of one-session biofeedback training in pediatric headache [clinical trial]. Neurology 2001; 56(1): 133

    Article  PubMed  CAS  Google Scholar 

  57. Helm-Hylkema H, Orlebeke JF, Enting LA, et al. Effects of behaviour therapy on migraine and plasma beta-endorphin in young migraine patients. Psychoneuroendocrinology 1990; 15(1): 39–45

    Article  Google Scholar 

  58. McGrath PJ. Recurrent headaches: making what works available to those who need it [commentary]. J Pediatr Psychol 1999; 24(2): 111–2

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

No sources of funding were used to assist in the preparation of this manuscript. The author has no conflicts of interest that are directly relevant to the content of this manuscript.

Author information

Authors and Affiliations

  1. Department of Neurology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA

    Robert J. Baumann

Authors
  1. Robert J. Baumann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert J. Baumann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baumann, R.J. Behavioral Treatment of Migraine in Children and Adolescents. Pediatr-Drugs 4, 555–561 (2002). https://doi.org/10.2165/00128072-200204090-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00128072-200204090-00001

Keywords

Search

Navigation