Download PDF
Semin Neurol 2006; 26(2): 199-207
DOI: 10.1055/s-2006-939920
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Behavioral Approaches to the Treatment of Migraine

Kenneth A. Holroyd1 , Jana B. Drew1
  • 1Department of Psychology, Ohio University, Athens, Ohio
Further Information

Publication History

Publication Date:
21 April 2006 (online)

    Permissions and Reprints

ABSTRACT

Behavioral interventions such as biofeedback training, relaxation training, and cognitive-behavior stress management therapy have been identified as efficacious treatments for migraine headache. These treatments, and the formats (clinic-based, limited-contact, and home-based) in which they are taught, are described in this article. Information about public health interventions (school, work, Internet, and mass media) is also briefly addressed. Results of studies examining the efficacy of behavioral treatments, how behavioral treatments compare in effectiveness, and how they can be integrated with pharmacotherapy are reviewed for both adult and pediatric populations. Finally, the role of behavioral treatments in migraine treatment guidelines is discussed, and factors that are associated with response to behavioral treatments are reviewed.

KEYWORDS

Migraine - behavior - biofeedback - cognitive - efficacy - guidelines

REFERENCES

  • 1 Schwartz M S, Andrasik F. Biofeedback: A Practitioner's Guide. 3rd ed. New York; Guilford Press 2003
    Google Scholar
  • 2 Holroyd K A, Lipchik G L, Penzien D B. Behavioral management of recurrent headache disorders. In: Silberstein SD, Lipton RB, Dalessio DJ Wolff's Headache and Other Headache Pain. 7th ed. New York; Oxford University Press 2001: 562-598
    Google Scholar
  • 3 Lipchik G L, Holroyd K A, Nash J M. Cognitive-behavioral management of recurrent headache disorders: a minimal-therapist contact approach. In: Turk DC, Gatchel RS Psychological Approaches to Pain Management. 2nd ed. New York; Guilford Press 2002: 356-389
    Google Scholar
  • 4 Blanchard E B, Andrasik F. Management of Chronic Headaches: A Psychological Approach. Elmsford, NY; Pergamon Press 1985
    Google Scholar
  • 5 Scharff L, Marcus D A. Interdisciplinary outpatient group treatment of intractable headache.  Headache. 1994;  34 73-78
    CrossrefPubMedGoogle Scholar
  • 6 Richardson G M, McGrath P J. Cognitive-behavioral therapy for migraine headaches: a minimal-therapist-contact approach versus a clinic-based approach.  Headache. 1989;  29 352-357
    CrossrefPubMedGoogle Scholar
  • 7 Teders S J, Blanchard E B, Andrasik F, Jurish S E, Neff D F, Arena J G. Relaxation training for tension headache: comparative efficacy and cost-effectiveness of a minimal therapist contact versus a therapist delivered procedure.  Behav Ther. 1984;  15 59-70
    PubMedGoogle Scholar
  • 8 Jurish S E, Blanchard E B, Andrasik F, Teders S J, Neff D F, Arena J G. Home- versus clinic-based treatment of vascular headache.  J Consult Clin Psychol. 1983;  51 743-751
    PubMedGoogle Scholar
  • 9 Haddock C K, Rowan A B, Andrasik F, Wilson P G, Talcott G W, Stein R J. Home-based behavioral treatments for chronic benign headache: a meta-analysis of controlled trials.  Cephalalgia. 1997;  17 113-118
    CrossrefPubMedGoogle Scholar
  • 10 McGrath P J, Humphreys P, Keene D et al.. The efficacy and efficiency of a self-administered treatment for adolescent migraine.  Pain. 1992;  49 321-324
    CrossrefPubMedGoogle Scholar
  • 11 Cottrell C, Drew J B, Waller S E, Holroyd K A, Brose J A, O'Donnell F J. Perceptions and needs of patients with migraine.  J Fam Pract. 2002;  51 142-147
    PubMedGoogle Scholar
  • 12 Connelly M, Rapoff M A, Thompson N, Connelly W. Headstrong: a pilot study of a CD-ROM intervention for recurrent pediatric headache.  J Pediatr Psychol. 2006;  31 1-11
    PubMedGoogle Scholar
  • 13 Cottrell C, Drew J, Gibson J, Holroyd K, O'Donnell F. Telephone administered behavioral treatment of adolescent migraine.  Headache. , In press
    PubMedGoogle Scholar
  • 14 Larsson B, Carlsson J, Fichtel A, Melin L. Relaxation treatment of adolescent headache sufferers: results from a school based replication series.  Headache. 2005;  45 692-704
    CrossrefPubMedGoogle Scholar
  • 15 Stewart W, Ricci J A, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the U.S. workforce.  JAMA. 2003;  290 2443-2454
    CrossrefPubMedGoogle Scholar
  • 16 Schneider W J, Furth P A, Blalock T H, Sherrill T A. A pilot study of a headache program in the workplace: the effect of education.  J Occup Environ Med. 1999;  41 202-209
    PubMedGoogle Scholar
  • 17 Strom L, Peterson R, Andersson G. A controlled trial of self-help treatment of recurrent headache conducted via the internet.  J Consult Clin Psychol. 2000;  68 722-727
    CrossrefPubMedGoogle Scholar
  • 18 Andersson G, Lundstom P, Strom L. A controlled trial of self-help treatment of recurrent headache conducted via the internet.  Headache. 2003;  43 353-361
    CrossrefPubMedGoogle Scholar
  • 19 Devineni T, Blanchard E B. A randomized controlled trial of an internet-based treatment for chronic headache.  Behav Res Ther. 2005;  43 277-292
    CrossrefPubMedGoogle Scholar
  • 20 Hicks C, von Baeyer C, McGrath P. Online psychological treatment for pediatric recurrent pain: a randomized evaluation.  J Pediatr Psychol. , In press
    PubMedGoogle Scholar
  • 21 de Bruijn-Kofman A T, van de Wiel H, Groenman N H, Sorbi M J, Klip E. Effects of a mass media behavioral treatment for chronic headache: a pilot study.  Headache. 1997;  37 415-420
    PubMedGoogle Scholar
  • 22 Blanchard E B, Andrasik F, Ahles T A, Teders S J, O'Keefe D M. Migraine and tension headache: a meta-analytic review.  Behav Ther. 1980;  11 613-631
    PubMedGoogle Scholar
  • 23 Blanchard E B. Psychological treatment of benign headache disorders.  J Consult Clin Psychol. 1992;  60 537-551
    PubMedGoogle Scholar
  • 24 Holroyd K A. Management of migraine and tension-type headaches. In: Trafton J Best Practices in the Behavioral Management of Chronic Disease: Neuropsychiatric Disorders. Vol. 1. Los Altos, CA; Institute for Disease Management 2003
    Google Scholar
  • 25 Silberstein S, Rosenberg J. Multispecialty consensus on diagnosis and treatment of headache.  Neurology. 2000;  54 1553-1554
    CrossrefPubMedGoogle Scholar
  • 26 Campbell J K, Penzien D B, Wall E M. Evidence-based guidelines for migraine headache: behavioral and physical treatments. U.S. Headache Consortium; Available at: http://www.aan.com/public/practiceguidelines/headache_gl.htm Accessed May 15, 2005
    Google Scholar
  • 27 Sarafino E, Goehring P. Age comparisons in acquiring biofeedback control and success in reducing headache pain.  Ann Behav Med. 2000;  22 10-16
    PubMedGoogle Scholar
  • 28 Hermann C, Kim M, Blanchard E B. Behavioral and pharmacological intervention studies of pediatric migraine: an exploratory meta-analysis.  Pain. 1995;  60 239-256
    CrossrefPubMedGoogle Scholar
  • 29 Holroyd K A, Penzien D D, Cordingley G. Propranolol in the management of recurrent migraine: a meta-analytic review.  Headache. 1991;  31 333-340
    CrossrefPubMedGoogle Scholar
  • 30 Holroyd K A, France J L, Cordingley G E et al.. Enhancing the effectiveness of relaxation/thermal biofeedback training with propranolol HCI.  J Consult Clin Psychol. 1995;  63 327-330
    PubMedGoogle Scholar
  • 31 Mathew N T. Prophylaxis of migraine and mixed headache: a randomized controlled study.  Headache. 1981;  21 105-109
    CrossrefPubMedGoogle Scholar
  • 32 Sartory G, Muller B, Metsch J, Pothmann R. A comparison of psychological and pharmacological treatment of pediatric migraine.  Behav Res Ther. 1998;  36 1155-1170
    PubMedGoogle Scholar
  • 33 Olness K, MacDonald J T, Uden D L. Comparison of self-hypnosis and propranolol in the treatment of juvenile migraine.  Pediatrics. 1987;  79 593-597
    PubMedGoogle Scholar
  • 34 Holden E W, Deichmann M M, Levy J D. Empirically supported treatments in pediatric psychology: recurrent pediatric headache.  J Pediatr Psychol. 1999;  24 91-109
    CrossrefPubMedGoogle Scholar
  • 35 Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S. Practice parameter: pharmacological treatment of migraine headache in children and adolescents.  Neurology. 2004;  63 2215-2224
    CrossrefPubMedGoogle Scholar
  • 36 Penzien D B, Rains J C, Andrasik F. Behavioral management of recurrent headache: three decades of experience and empiricism.  Appl Psychophysiol Biofeedback. 2002;  27 163-181
    CrossrefPubMedGoogle Scholar
  • 37 Holroyd K A. Assessment and psychological management of recurrent headache disorders.  J Consult Clin Psychol. 2002;  70 656-677
    CrossrefPubMedGoogle Scholar
  • 38 Lipton R B, Stewart W, Stone A, Lainez M, Sawyer J. Stratified care vs step care strategies for migraine: the Disability in Strategies of Care (DISC) study: a randomized trial.  JAMA. 2000;  284 2599-2605
    CrossrefPubMedGoogle Scholar
  • 39 Lipton R. Disability assessment as a basis for stratified care.  Cephalalgia. 1998;  18(suppl 22) 40-46
    PubMedGoogle Scholar
  • 40 Lipton R B, Bigal M E, Stewart W F. Disease management of migraine and the importance of stratified care.  Dis Manage Health Outcomes. 2003;  11 379-388
    PubMedGoogle Scholar
  • 41 Holroyd K A, Penzien D B. Psychosocial interventions in the management of recurrent headache disorders. 1: overview and effectiveness.  Behav Med. 1994;  20 53-63
    PubMedGoogle Scholar
  • 42 Holroyd K A, Lipchik G L, Penzien D B. Psychological management of recurrent headache disorders: empirical basis for clinical practice. In: Dobson KS, Craig KD Best Practice: Developing and Promoting Empirically Supported Interventions. Newbury Park, CA; Sage 1998: 193-212
    Google Scholar
  • 43 Holroyd K A, Penzien D B. Client variables in the behavioral treatment of recurrent tension headache: a meta-analytic review.  J Behav Med. 1986;  9 515-536
    CrossrefPubMedGoogle Scholar
  • 44 Mosley T H, Grotheus C A, Meeks W M. Treatment of tension headache in the elderly: a controlled evaluation of relaxation training and relaxation combined with cognitive-behavior therapy.  J Clin Geropsychol. 1995;  1 175-188
    PubMedGoogle Scholar
  • 45 Radat F, Swendsen J. Psychiatric comorbidity in migraine: a review.  Cephalalgia. 2005;  25 165-178
    CrossrefPubMedGoogle Scholar
  • 46 Spitzer R L, Williams J BW, Kroenke K et al.. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME MD 1000 study.  JAMA. 1994;  272 1749-1756
    Google Scholar
  • 47 Andrasik F. Behavioral treatment approaches to chronic headache.  Neurol Sci. 2003;  24 S80-S85
    PubMedGoogle Scholar
  • 48 Grazzi L, Andrasik F, D'Amico D et al.. Behavioral and pharmacologic treatment of transformed migraine with analgesic overuse: outcome at 3 years.  Headache. 2002;  42 483-490
    CrossrefPubMedGoogle Scholar
  • 49 Hermann C, Blanchard E B, Flor H. Biofeedback treatment for pediatric migraine: prediction of treatment outcome.  J Consult Clin Psychol. 1997;  65 611-616
    PubMedGoogle Scholar
  • 50 Osterhaus S, Lange A, Linssen W HJP, Passchier J. A behavioral treatment of young migrainous and nonmigrainous headache patients: prediction of treatment success.  Int J Behav Med. 1997;  4 378-396
    CrossrefPubMedGoogle Scholar
  • 51 Osterhaus S OL, Passchier J, van der Helm-Hylkema H et al.. Effects of behavioral psychophysiological treatment on schoolchildren with migraine in a nonclinical setting: predictors and process variables.  J Pediatr Psychol. 1993;  18 697-715
    PubMedGoogle Scholar

Kenneth A HolroydPh.D. 

Edwin and Ruth Kennedy Distinguished Professor, Department of Psychology, Ohio University

225 Porter Hall, Athens, OH 45701-2979