Psychological interventions for migraine: a systematic review
Open accessAbstract
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://www.opengrey.eu , the meta-register of controlled trials and bibliographies. Twenty-four 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 mid-point (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 headache-related 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 UK.
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Several reviews provide evidence for the efficacy of behavioral approaches in migraine prophylaxis.
“Several reviews provide evidence for the efficacy of behavioral approaches in migraine prophylaxis (13, 14).”
From Efficacy of Cognitive-Behavioral Therapy for the Prophylaxis of Migraine in Adults: A Three-Armed Randomized Controlled Trial (2022) · cites this paper as [14]
Relaxation, biofeedback, and CBT are presumably effective to a similar extent.
“Relaxation, biofeedback, and CBT are presumably effective to a similar extent (14, 15).”
From Efficacy of Cognitive-Behavioral Therapy for the Prophylaxis of Migraine in Adults: A Three-Armed Randomized Controlled Trial (2022) · cites this paper as [14]
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“Relaxation, biofeedback, and CBT are presumably effective to a similar extent (14, 15).”
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Liu, Y., Liu, Y., Pan, H., & Wang, W. (2025) · The Journal of Headache and Pain · doi:10.1186/s10194-025-02049-5 · Cited by 17 · see citing works
“Additionally, consistent with clinical research, psychological health indicators including feelings of misery demonstrated detrimental effects on migraine risk, manifesting through pathogenic psychoneuro-inflammatory axes and increased disability risk [45–47].”
Gandolfi, M., Donisi, V., Marchioretto, F., Battista, S., Smania, N., & Piccolo, L. D. (2019) · Toxins · doi:10.3390/toxins11090504 · Cited by 17 · see citing works
“Although these approaches vary somewhat, they have all shown to influence maladaptive behaviours and ways of thinking that contribute to headache-related burden and pain [43,44].”
BackgroundKhazraee, H., Bakhtiari, M., Kianimoghadam, A. S., & Hajmanouchehri, R. (2023) · Life · doi:10.3390/life13010131 · Cited by 13 · see citing works
Psychological Approaches for Migraine Management
Sturgeon, J. A., Ehde, D. M., Darnall, B. D., Barad, M. J., Clauw, D. J., & Jensen, M. P. (2023) · Anesthesiology Clinics · doi:10.1016/j.anclin.2023.02.002 · Cited by 13 · see citing works
Consensus recommendations on the role of nurses in headache care: A European e-Delphi study
Rasmussen, A. V., Jensen, R., Gantenbein, A. R., Sumelahti, M., Braschinsky, M., Lagrata, S., Tamela, K., Trouerbach‐Kraan, J. P., Matharu, M. S., Dalevi, V., et al. (2024) · Cephalalgia · doi:10.1177/03331024241252161 · Cited by 11 · see citing works
“Additionally, relaxation techniques have been identified as beneficial in the treat-ment of migraine (56,57).”
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sEMG Biofeedback for Episodic Migraines: A Pilot Randomized Clinical Trial
Lazaridou, A., Paschali, M., Bernstein, C. A., Curiel, M., Moore, S. E., & Edwards, R. R. (2024) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-023-09615-0 · Cited by 9 · see citing works
“There are several studies that explored the effectiveness of biofeedback for migraine (Nestoriuc & Martin, 2007; Vasudeva et al., 2003);recent systematic reviews also point out the effectiveness of psychological therapies for migraine management (Sullivan et al., 2016).”
Tam, A. C. T., Naik, H., Trenaman, L., Lynd, L. D., & Zhang, W. (2024) · The Journal of Headache and Pain · doi:10.1186/s10194-024-01882-4 · Cited by 9 · see citing works
Huang, Y., Lin, L. W., Li, X.-Y., Chen, B. F., Yuan, L., & Zheng, H. (2024) · npj Digital Medicine · doi:10.1038/s41746-024-01264-9 · Cited by 8 · see citing works
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Integrated care for migraine and chronic tension-type headaches: A prospective observational study
Cramer, H., Hehlke, M., Vasmer, J., Rampp, T., Anheyer, D., Saha, F. J., Paul, A. E., Lauche, R., & Dobos, G. (2019) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2019.04.001 · Cited by 7 · see citing works
Reframing pain: the power of individual and societal factors to enhance pain treatment
Slater, R., Eccleston, C., Williams, A. C. D. C., Vincent, K., Linde, M., Hurley, M., & Laughey, W. F. (2024) · PAIN Reports · doi:10.1097/pr9.0000000000001161 · Cited by 6 · see citing works
“9 For example, in the management of migraine, there is now very good evidence for a range of psychological and behavioural interventions, including biofeedback, relaxation training, and cognitive behavioural therapy (CBT), 41 which reduce the frequency and/or severity of attacks.”
BackgroundBiofeedback and Neurofeedback in the Treatment of Migraine
Živoder, I., Martić-Biočina, S., & Kosić, A. V. (2018) · InTech eBooks · doi:10.5772/intechopen.76534 · Cited by 6 · see citing works
“Combination of pharmacologic and behavioral treatments such as relaxation training and cognitive behavior therapy can lead to faster and better results with people who suffer from migraine [43, 44].”
BackgroundSoleimanian-Boroujeni, F., Badihian, N., Badihian, S., Shaygannejad, V., & Gorji, Y. (2022) · BMC Neurology · doi:10.1186/s12883-022-02729-8 · Cited by 5 · see citing works
“Method: This study was conducted on 40 PwM aged 20–50 years.”
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“The main psychological interventions as treatments for migration include relaxation training, cognitive behavioral therapy and biofeedback [34].”
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Taxer, B., von Piekartz, H., Lauth, W., Christova, M., & Leis, S. (2024) · Applied Sciences · doi:10.3390/app14188102 · Cited by 4 · see citing works
“The lack of differences in the area of psychological components is surprising, as large-scale reviews indicate an increased occurrence of these phenomena [64,65], and studies indicate the effectiveness of psychological interventions in the management of migraine [66].”
Psychologische Behandlungsverfahren bei Kopfschmerz
Dresler, T., Klan, T., Liesering‐Latta, E., Lüpke, J., Hubalek, I. A., Kraya, T., & Kropp, P. A. (2019) · Nervenheilkunde · doi:10.1055/a-0989-6551 · Cited by 4 · see citing works
“[7] Sullivan A, Cousins S, Ridsdale L.”
Espanioli, A., van den Hoogen, N. J., Kuziek, J. W. P., Sjonnesen, K., Noel, M. E., & Orr, S. L. (2025) · Headache The Journal of Head and Face Pain · doi:10.1111/head.15039 · Cited by 3 · see citing works
“27 The recruitment period spanned from May 2019 to FIGURE 1 Flowchart showing number of participants included and excluded.”
Aktuelle Entwicklungen in der psychologischen Kopfschmerztherapie
Dresler, T., Klan, T., Kraya, T., & Kropp, P. A. (2018) · NeuroTransmitter · doi:10.1007/s15016-018-6212-4 · Cited by 3 · see citing works
Selvakumar, K., Fan, T. L., Nien, F. C., & Kit, M. H. (2023) · PLoS ONE · doi:10.1371/journal.pone.0291534 · Cited by 3 · see citing works
“And also, currently, the headache disorder being a bio-psychosocial phenomenon, pharmacotherapy fails to address the psychological and social factors [5].”
Guerra, F., Giacomo, D. D., Ranieri, J., Saporito, G., Sucapane, P., Totaro, R., & Pistoia, F. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1418188 · Cited by 3 · see citing works
“The most recent literature review highlighted the efficacy range of Cognitive Behavioral Therapy (CBT), Relaxation Training (RT), and Biofeedback (BF) as the most commonly applied non-pharmacological interventions, ranging from 20 to 67% (15, 31).”
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Wirkungsweise und Anwendung des Biofeedbacks am Beispiel von Kopfschmerzen
Kropp, P. A., Niederberger, U., & Dresler, T. (2021) · Psychotherapeut · doi:10.1007/s00278-021-00499-1 · Cited by 2 · see citing works
Grinberg, A. S., Rogers, D. G., Datre, O., Anthony, S., Clark, S. W., Takagishi, S. C., Seng, E. K., Fenton, B. T., Ney, J. P., & Sico, J. J. (2025) · Cephalalgia · doi:10.1177/03331024251351598 · Cited by 1 · see citing works
Taxer, B., Lauth, W., von Piekartz, H., Trinka, E., & Leis, S. (2025) · Neurology and Therapy · doi:10.1007/s40120-025-00824-9 · Cited by 1 · see citing works
“The absence of disparities in the domain of psychological components is noteworthy, given the findings of extensive reviews that suggest an increased prevalence of these phenomena [81, 82], and research has demonstrated the efficacy of psychological interventions in the management of migraine [83].”
Achieving a balance between the physical and the psychological in headache
Underwood, R., Kennis, K., & Ridsdale, L. (2017) · British Journal of General Practice · doi:10.3399/bjgp17x692093 · Cited by 1 · see citing works
Aktuelle Entwicklungen in der psychologischen Kopfschmerztherapie
Dresler, T., Klan, T., Kraya, T., & Kropp, P. A. (2018) · Schmerzmedizin · doi:10.1007/s00940-018-0869-4 · Cited by 1 · see citing works
Efficacy of biofeedback in treatment of migraine
Rosario, D. J., Ashwith, B., & Sequeira, A. (2023) · International Journal of Research in Medical Sciences · doi:10.18203/2320-6012.ijrms20230338 · Cited by 1 · see citing works
Zhao, Y. J., Jion, Y. I., Ho, K.-H., Wong, P. S., Lo, Y. L., Chan, Y. C., Ang, L. L., Yeo, S. N., Soh, S. B., Wu, T. S., et al. (2023) · Singapore Medical Journal · doi:10.4103/singaporemedj.smj-2022-195 · Cited by 1 · see citing works
The Experience and Opinions of Migraineurs about Complementary/Alternative Medicine Therapies
Ertsey, C. (2016) · doi:10.24947/baojn/2/3/124 · Cited by 1 · see citing works
Complementary and Integrative Medicine for the Pathways Model
McGrady, A. V., & Moss, D. (2018) · Springer eBooks · doi:10.1007/978-3-319-89313-6_5 · Cited by 1 · see citing works
Chiropractic spinal manipulative therapy for migraine
Chaibi, A. (2017) · NORA - Norwegian Open Research Archives · Cited by 1 · see citing works
Behavioral Approaches to CDH: Evidence and Outcomes
Slater, S. K., & O’Brien, H. L. (2018) · Springer eBooks · doi:10.1007/978-3-319-91491-6_17
Aktuelle Entwicklungen in der psychologischen Kopfschmerztherapie
Dresler, T., Klan, T., Kraya, T., & Kropp, P. A. (2019) · CME · doi:10.1007/s11298-019-6902-7
Mouodi, S., Mouodi, M., Majd, S. R., & Majd, A. R. (2020) · Cyprus Journal of Medical Sciences · doi:10.5152/cjms.2019.681
Soleimanian-Boroujeni, F., Badihian, N., Badihian, S., Shaygannejad, V., & Gorji, Y. (2022) · Research Square · doi:10.21203/rs.3.rs-1143097/v1
Therapeutic Opportunities for Headaches and Migraines in Pediatric Populations: A Review
Raghuvanshi, D. S., Chaudhary, R., & Singh, N. (2021) · Journal of Pharmaceutical Research International · doi:10.9734/jpri/2021/v33i60a34479
Exploring social cognition in migraine: a narrative review
Batti, V., Piella, E. M., Cermelli, A., Lombardo, C., Roveta, F., Rainero, I., & Rubino, E. (2025) · Confinia Cephalalgica · doi:10.4081/cc.2025.15787
Prevalence and burden of migraine in university students in Ireland: a cross-sectional study
Flynn, O., Fullen, B. M., Tamulevicius, N., & Blake, C. M. (2026) · Physical Therapy Reviews · doi:10.1080/10833196.2026.2626891
“Headache diaries and stress management strategies are commonly recommended, although overall evidence quality is variable and methodological limitations remain [36,37].”
Lucia, A. D., Donisi, V., Rimondini, M., Piccolo, L. D., & Perlini, C. (2026) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2026.2650006
“Previous literature reviews showed the effectiveness and feasibility of psychological interventions for CH in adults, (e.g. Dudeney et al., 2022; Lee et al., 2019; Sullivan et al., 2016; Szok et al., 2023).”
- Authors
- Sullivan, A., Cousins, S., & Ridsdale, L.
- Affiliations
- King's College London (GB)
- Corresponding author
- Ridsdale, Leone
- Venue
- Journal of Neurology
- Published
- 2016-05-09
- Volume
- 263
- Issue
- 12
- Pages
- 2369-2377
- ISSN
- 0012-1037 (ISSN-L)
- 0340-5354
- 1432-1459
- PMC
- PMC5110589
- OpenAlex
- W2345672416
- Cited by
- 73
- References
- 48
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 8 · 2023: 5 · 2022: 7 · 2021: 6 · 2020: 4 · 2019: 14 · 2018: 11 · 2017: 7 · 2016: 4
- FWCI
- 1.71
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Neurology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion, cc-by)
- Bristol Research (University of Bristol) (publishedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (PB-PG-0610-22373)
- Research for Patient Benefit Programme
- 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, psychological intervention, disability, quality of life, efficacy, NICE guidelines, trial quality, universal health care
- MeSH terms
- Humans, Migraine Disorders, Psychotherapy, Databases as Topic
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