CoChat
Sign Up
Cited by 59Migraine and Headache StudiesTemporomandibular Joint DisordersMusculoskeletal pain and rehabilitation

Psychological therapies for the prevention of migraine in adults

Sharpe, Louise, Dudeney, Joanne, Williams, Amanda C de C, Nicholas, Michael, McPhee, Ingrid, Baillie, Andrew, Welgampola, Miriam, McGuire, Brian·2019·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd012295.pub2
Open this paper in CoChat — free account

Abstract

Background Migraine is a common neurological problem associated with the highest burden amongst neurological conditions in terms of years lived with disability. Medications can be used as prophylaxis or rescue medicines, but are costly and not always effective. A range of psychological interventions have been developed to manage migraine. Objectives The objective was to evaluate the efficacy and adverse events of psychological therapies for the prevention of migraine in adults. Search methods We searched CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL from their inception until July 2018, and trials registries in the UK, USA, Australia and New Zealand for randomised controlled trials of any psychological intervention for adults with migraine. Selection criteria We included randomised controlled trials (RCTs) of a psychological therapy for people with chronic or episodic migraine, with or without aura. Interventions could be compared to another active treatment (psychological or medical), an attention‐placebo (e.g. supportive counselling) or other placebo, routine care, or waiting‐list control. We excluded studies where fewer than 15 participants completed each arm. Data collection and analysis We extracted study characteristics and outcome data at post‐treatment and the longest available follow‐up. We analysed intervention versus control comparisons for the primary outcome of migraine frequency. We measured migraine frequency using days with migraines or number of migraine attacks measured in the four weeks after treatment. In addition, we analysed the following secondary outcomes: responder rate (the proportion of participants with a 50% reduction in migraine frequency between the four weeks prior to and the four weeks after treatment); migraine intensity; migraine duration; migraine medication usage; mood; quality of life; migraine‐related disability; and proportion of participants reporting adverse events during the treatment. We included these variables, where available, at follow‐up, the timing of which varied between the studies. We used the GRADE approach to judge the quality of the evidence. Main results We found 21 RCTs including 2482 participants with migraine, and we extracted meta‐analytic data from 14 of these studies. The majority of studies recruited participants through advertisements, included participants with migraine according to the International Classification of Headache Disorders (ICHD) criteria and those with and without aura. Most intervention arms were a form of behavioural or cognitive‐behavioural therapy. The majority of comparator arms were no treatment, routine care or waiting list. Interventions varied from one 20‐minute session to 14 hours of intervention. No study had unequivocally low risk of bias; all had at least one domain at high risk of bias, and 20 had two to five domains at high risk. Reporting of randomisation procedures and allocation concealment were at high or unclear risk of bias. We downgraded the quality of evidence for outcomes to very low, due to very serious limitations in study quality and imprecision. Reporting in trials was poor; we found no preregistrations stipulating the outcomes, or demonstrating equivalent expectations between groups. Few studies reported our outcomes of interest, most only reported outcomes post treatment; follow‐up data were sparse. Post‐treatment effects We found no evidence of an effect of psychological interventions for migraine frequency in number of migraines or days with migraine (standardised mean difference (SMD) −0.02, 95% confidence interval (CI) −0.17 to 0.13; 4 studies, 681 participants; very low‐quality evidence). The responder rate (proportion of participants with migraine frequency reduction of more than 50%) was greater for those who received a psychological intervention compared to control: 101/186 participants (54%) with psychological therapy; 37/152 participants (24%) with control (risk ratio (RR) 2.21, 95% CI 1.63 to 2.98; 4 studies, 338 participants; very low‐quality evidence). We found no effect of psychological therapies on migraine intensity (SMD −0.13, 95% CI −0.28 to 0.02; 4 studies, 685 participants). There were no data for migraine duration (hours of migraine per day). There was no effect on migraine medication usage (SMD −0.06, 95% CI −0.35 to 0.24; 2 studies, 483 participants), mood (mean difference (MD) 0.08, 95% CI −0.33 to 0.49; 4 studies, 432 participants), quality of life (SMD −0.02, 95% CI −0.30 to 0.26; 4 studies, 565 participants), or migraine‐related disability (SMD −0.67, 95% CI −1.34 to 0.00; 6 studies, 952 participants). The proportion of participants reporting adverse events did not differ between those receiving psychological treatment (9/107; 8%) and control (30/101; 30%) (RR 0.16, 95% CI 0.00 to 7.85; 2 studies, 208 participants). Only two studies reported adverse events and so we were unable to draw any conclusions. We rated evidence from all studies as very low quality. Follow‐up Only

Integrity signals

Registry

Crossref · 10.1002/14651858.cd012295.pub2

Cites

109 of 109 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Sharpe, L., Dudeney, J., Williams, A. C. D. C., Nicholas, M., McPhee, I., Baillie, A., Welgampola, M., & McGuire, B.
Affiliations
  • The University of Sydney (AU)
  • Seattle Children's Research Institute (US)
  • University College London (GB)
  • Institute of Neurosciences; Department of Neurology; Sydney Australia
  • National University of Ireland (IE)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2019-07-02
Volume
2019
Issue
7
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd012295.pub2
OpenAlex
W3046272729
Cited by
59
References
104
Citations by year
2026: 4 · 2025: 5 · 2024: 8 · 2023: 11 · 2022: 10 · 2021: 11 · 2020: 8 · 2019: 2
FWCI
1.31
Type
journal article
Language
en
Open access
closed
Locations
Cochrane Database of Systematic Reviews (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
  • Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
migraine prophylaxis, psychotherapy, cognitive behavioral therapy, behavior therapy, migraine frequency, migraine disability, adverse events, chronic migraine, episodic migraine, migraine with aura, quality of life, mood, migraine intensity, migraine duration, treatment efficacy, treatment burden, medication adherence, treatment discontinuation, cost-effectiveness, cost-effectiveness ratio, cost-benefit analysis

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review