Authors: Andrew Sullivan Sian Cousins Leone Ridsdale
Publish Date: 2016/05/09
Volume: 263, Issue: 12, Pages: 2369-2377
Abstract
Migraine causes major health impairment and disability Psychological interventions offer an addition to pharmacotherapy but they are not currently recommended by the National Institute of Clinical Excellence NICE or available in the National Health Service We aimed to systematically review evidence on the efficacy of psychological interventions for migraine in adults A search was done of MEDLINE psychINFO http//wwwopengreyeu the metaregister of controlled trials and bibliographies Twentyfour papers were included and rated independently by two people using the Yates scale which has 35 points Cochrane recommendations are that high quality reports score above the midpoint 18 points Methods used in 17/24 papers were rated ‘high quality’ However frequently descriptions of key areas such as randomisation methods were omitted Eighteen studies measured effects of psychological interventions on headacherelated outcomes fifteen reporting significant improvements ranging 20–67 Interventions also produced improvements in psychological outcomes Few trials measured or reported improvement in disability or quality of life We conclude that evidence supports the efficacy of psychological interventions in migraine Over half of the studies were from the USA which did not provide universal health care at the time of the study so it is difficult to generalise results to typical populations in receipt of publically funded health services We agree with the NICE recommendation that high quality pragmatic randomised controlled trials are needed in the UKMigraine is a profoundly debilitating condition ranked by the World Health Organisation WHO as one of the top 20 causes of disability worldwide 1 It results in loss of quality of life QoL as well as having a significant impact on society as a whole In the United Kingdom UK approximately 25 million work days are lost to migraine each year with headache disorders estimated to cost the economy in excess of £5 billion per year 2 3 Current treatment for migraine is primarily focussed on pharmacological interventions however these treatments only show moderate efficacy With headache disorders now considered a biopsychosocial phenomenon pharmacotherapy fails to address underlying psychological and social factors influencing headache 4 Evidence also shows that migraine may be comorbid with psychiatric conditions notably anxiety and depression 5 As such psychological interventions are considered as a possible alternative or adjunct to pharmacotherapyThe main psychological interventions employed as treatment for migraine include relaxation training RT cognitive behavioural therapy CBT and biofeedback BF Despite over 40 years of research into these treatments and endorsement by organisations worldwide including the US Headache Consortium and WHO they are not currently recommended for use in migraine patients in the UK 6 7 However in 2012 the National Institute of Clinical Excellence NICE issued a research recommendation for a pragmatic randomised controlled trial RCT to be conducted to determine the efficacy of psychological interventions for treatment of chronic headache perhaps paving the way for future provision of these interventions in UK clinical practice 8 To this end a pilot trial was undertaken at King’s College London to assess the feasibility of trialling CBT combined with RT for chronic migraine in adults 9 In this context we reviewed the literature on psychological interventions for migraine at this timeGoslin et al 10 previously systematically reviewed psychological interventions for migraine in 1999 concluding that BF RT and CBT have modest efficacy Subsequent systematic reviews have since focussed on BF and paediatric populations 11 12 13 Therefore an uptodate overview of the psychological interventions for adult migraineurs is currently needed In light of this we aimed to systematically review the evidence regarding the efficacy of psychological interventions for treatment of adult migraine since 1999Studies were excluded if 1 they did not report a specific headache diagnosis 2 they included populations of other headache disorders such as cluster headache 3 they employed nonpsychological interventions such as physical therapy 4 there were no results published 5 only physiological outcomes were reportedStudies with mixed populations of migraine and tension type headache TTH were included because these disorders represent a heterogeneous group and to exclude such studies would exclude a significant part of the migraine literature Goslin et al 10 also included such studies in their reviewAn electronic search was carried out for published and unpublished trials of the databases 1 MEDLINE 2 psychINFO 3 opengreyeu and 4 the metaregister of controlled trials This was carried out using the key words “migraine disorder” “migraine with aura” “migraine without aura” “migraine” and “migraine headache” combined with “cognitive therapy” “behaviour therapy” “cognitive behavioural therapy” “relaxation therapy” “relaxation training” and “biofeedback” A manual search of relevant bibliographies was also performed
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