Non-pharmacological self-management with CBT, Patient Education, Mindfulness and Relaxation for Migraine and Tension-Type Headache: A Systematic Review
Non-pharmacological self-management interventions for people living with migraine or tension-type headache appear to be effective but evidence is limited and optimum content and delivery methods are not known
We searched five relevant electronic databases for randomised, controlled trials of non-pharmacological self-management interventions for people living with migraine and/or tension type headache published in English from 1980 to June 2016, excluding biofeedback and exercise.
We extracted details of intervention content, assessed methodological quality and classified interventions according to their delivery methods and the content of interventions. We assessed the overall effectiveness of included self-management interventions vs. usual care and assessed the effectiveness of intervention components and delivery methods.
We found a small overall effect of self-management interventions versus usual care, with an SMD of-0.36 (-0.45 - -0.26) on pain intensity and -0.32 (-0.42 - -0.22) on headache related disability.
Studies including a CBT component found a larger effect size of -0.72 (-0.93 - -0.51) compared to those without of -0.41 (-0.58, -0.24) on mood, but made no difference on pain intensity or headache related disability
Studies including educational components found a larger effect size on pain intensity of -0.51 (-0.68 - -0.34) compared to -0.28 (-0.40 - -0.16) for those without.
Studies including a mindfulness component found a larger effect size on pain intensity of -0.50 (-0.82 - -0.18) compared to those without 0.34 (-0.44, -0.24).
Studies of group-delivered interventions found a larger effect on pain intensity; effect size of 0.56 (-0.72 - 0.40) compared to -0.39 (-0.52 - -0.27) for individually delivered interventions.
Overall we found that self-management interventions for migraine and tension-type headache are slightly more effective than usual care in reducing pain intensity and headache related disability. The findings also suggest that including CBT, mindfulness and educational components in interventions, and delivery in groups may increase effectiveness.