Non-Pharmacological Self-Management of Migraine or Tension-type Headache: A Systematic Review

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Non-Pharmacological Self-Management of Migraine or Tension-type Headache: A Systematic Review
Key Take-Away: 

The self-management interventions for migraine and tension-type headache are more effective than usual care in reducing pain intensity, mood and headache-related disability, but have no effect on headache frequency.

Self-managed non-pharmacological interventions have been encouraged as an optimistic option for people with intractable chronic conditions. The self-management of migraine and tension-type headaches can be done either alongside pharmacological interventions or as a stand-alone therapy, particularly when other treatment options have failed, or a person prefers a non-pharmacological intervention.

ABSTRACT: 
Background: 

Self-managed non-pharmacological interventions have been encouraged as an optimistic option for people with intractable chronic conditions. The self-management of migraine and tension-type headaches can be done either alongside pharmacological interventions or as a stand-alone therapy, particularly when other treatment options have failed, or a person prefers a non-pharmacological intervention. Headache management is strongly influenced by behavioral factors; therefore, these treatments are aimed at enabling patients to handle pain and symptoms associated with their headaches more effectively. The basic rationale behind promoting self-management in headache is that people can learn ways to help themselves manage their headaches better and that this can have a positive effect on both physical symptoms and functional capacity. The two common approaches are biofeedback and exercise/physical therapy. However, this study focuses on various approaches, but interventions differ considerably in terms of content and delivery for supporting the use of self-management interventions.

In this study, the effect of self-management interventions commonly included in trials in migraine and tension-type headache populations were quantified. Also, the effects of interventions that included specific components compared with those that did not include them were explored. This study was conducted to inform the formation of a complex non-pharmacological intervention for the Chronic Headache Education and Self-Management Study (CHESS). The CHESS aims to develop a sustainable non-pharmacological educational self-management intervention for people with chronic migraine/and or tension-type headache. In this systematic review, the self-management practices by educational and psychological approaches and sustainable interventions without the use of any apparatus were focused without including biofeedback or exercise/physical therapy.

Rationale behind the research

  • There are limited evidences in literature about mindfulness-based therapies for non-pharmacological self-management of migraine and headache. Therefore, this research focuses on both mindfulness and acceptance-based approaches for self-management of migraine.

Objective

To assess the effect of non-pharmacological self-management interventions against usual care, and to explore different components and delivery methods within those interventions.

Methods: 

 

  • Study outcome measures
  • The study outcomes included were headache frequency (headache days per month), pain intensity, headache-related disability, measures of quality of life, mood (measures of anxiety and depression) or medication consumption.
  • Time Points: Not described
Results: 

 

Study outcomes

  1. Baseline: There were no significant baseline differences between the groups.
  • A small overall effect for the superiority of self-management interventions over usual care, with a standardized mean difference (SMD) of −0.36 (−0.45 to −0.26) for pain intensity; −0.32 (−0.42 to −0.22) for headache-related disability, 0.32 (0.20 to 0.45) for quality of life and a moderate effect on mood (SMD=0.53 (−0.66 to −0.40)) was obtained.
  • There was no effect seen on headache frequency (SMD=−0.07 (−0.22 to 0.08)).
  • Assessment of components and characteristics suggests a larger effect on pain intensity in interventions that included explicit educational components (−0.51 (−0.68 to −0.34) vs −0.28 (−0.40 to −0.16)); mindfulness components (−0.50 (−0.82 to −0.18) vs 0.34 (−0.44 to −0.24)) and in interventions delivered in groups vs one-to-one delivery (0.56 (−0.72 to −0.40) vs −0.39 (−0.52 to −0.27)) and larger effects on mood in interventions including a cognitive–behavioral therapy (CBT) component with an SMD of −0.72 (−0.93 to −0.51)
Conclusion: 

The study concluded that self-management interventions improves many headache-related outcomes but have no effect on headache frequency when compared with usual care for migraine and tension-type headache. There occurs some preliminary evidence that delivery of self-management interventions in groups, including CBT, educational and mindfulness components, appears to be associated with larger effects. Some evidences guide research-based decisions about intervention content and delivery details of self-management interventions that aim to improve patients’ capacity to manage their headaches.

The results were significant, but there is need of further research in order to confirm and consider the optimal duration, and amount of contact hours and length of self-management interventions to help patients manage their headaches.  Further methodological research is needed to explore the interactions between components and possible additive and/or synergistic effects of components in self-management interventions.

Probyn K, Bowers H, Mistry D, et al. BMJ Open 2017;7:e016670.
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