Non-pharmacological self-management with CBT, Patient Education, Mindfulness and Relaxation for Migraine and Tension-Type Headache: A Systematic Review

Talk Code: 
Martin Underwood
Katrin Probyn, Hannah Bowers, Dipesh Mistry, Fiona Caldwell, Martin Underwood, Shilpa Patel , Harbinder Sandhu Manjit Matharu, Tamar Pincus on behalf of the CHESS team
Author institutions: 
1. Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham, Surrey, TW20 0EX, UK. 2. Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. 3.Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG. UK


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.

Submitted by: 
Katrin Probyn
Funding acknowledgement: 
This research was funded by the NIHR Programme Grants for Applied Research programme (RP-PG-1212-20018). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.