Adherence to Behavioral Therapy for Migraine: Knowledge to Date, Mechanisms for Assessing Adherence, and Methods for Improving Adherence
Open accessAbstract
Purpose of review In other disease states, adherence to behavioral therapies has gained attention, with a greater amount of studies discussing, defining, and optimizing adherence. For example, a meta-analysis formally discussed adherence in 25 studies of CBT for 11 different disorders, with only 6 of the 25 omitting addressing or defining adherence. Many studies have discussed the use of text messages, graph-based adherence rates, and email/telephone reminders to improve adherence. This paper examined the available literature regarding adherence to behavioral therapy for migraine as well as adherence to similar therapies in other disease states. The goal of this research is to apply lessons learned from adherence to behavioral therapy for other diseases in better understanding how we can improve adherence to behavioral therapy for migraine.Recent findings Treatment for migraine typically includes both pharmacologic and non-pharmacologic therapies, including progressive muscle relaxation (PMR), cognitive behavioral therapy (CBT), and biofeedback. Behavioral therapies have been shown to significantly reduce headache frequency and intensity, but high attrition rates and suboptimal adherence can undermine their efficacy. Traditionally, adherence to behavioral therapy has been defined by self-report, including paper headache diaries and assignments. In person attendance has also been employed as a method of defining and monitoring adherence. With the advent of personal electronics, measurements of adherence have shifted to include electronic-based methods such as computer-based programs and mobile-based therapies. Furthermore, some studies have taken advantage of electronic methods such as email reminders, push notifications, and other mobile-based reminders to optimize adherence. The JITA-I, a novel method of engaging individual patient adherence, has also been suggested as a possible method to improve adherence by tailoring engagement with a mobile health app-based on patient input. These novel methods may be utilized in behavioral therapy for migraine for further optimizing adherence. Few intervention studies to date have addressed the optimal ways to impact adherence to migraine behavioral therapy. Further research is required regarding adherence with behavioral therapies, specifically via mobile health interventions to better understand how to define and improve adherence via this novel forum. Once we are able to understand optimal methods of tracking adherence, we will be better equipped to understand the role of adherence in shaping outcomes for behavioral therapy in migraine.
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In behavioral headache treatment, engagement has yet to be thoroughly assessed in terms of dose and duration; however, earlier studies reported high dropout rates.
“In behavioral headache treatment, engagement has yet to be thoroughly assessed in terms of dose and duration; however, earlier studies reported high dropout rates [124].”
Several studies found that psychological therapies delivered by telephone were as effective as face-to-face treatment, had comparable therapeutic alliance, and satisfied participants.
“Several studies have demonstrated that psychological therapies delivered by telephone were as effective as face-to-face treatment,37 therapeutic alliance was comparable, and participants were satisfied with this model of delivery. 38”
From A Pilot Randomized Controlled Trial to Assess the Impact of Motivational Interviewing on Initiating Behavioral Therapy for Migraine (2020) · cites this paper as [38]
The sections on tracking behavioral-therapy adherence and adherence in other disease states (pages unavailable) discuss internet-based treatment and mobile tools, but do not report telephone therapy being as effective as face-to-face treatment. Searches for telephone delivery, therapeutic alliance, and participant satisfaction found no passage addressing those comparisons. (LLM, conf=0.78)
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- Authors
- Gewirtz, A., & Minen, M.
- Affiliations
- NYU Langone Health (US)
- Corresponding author
- Minen, Mia
- Venue
- Current Pain and Headache Reports
- Published
- 2019-01
- Volume
- 23
- Issue
- 1
- Pages
- 3-3
- ISSN
- 1531-3433 (ISSN-L)
- 1534-3081
- PMC
- PMC6838777
- OpenAlex
- W2909622205
- Cited by
- 22
- References
- 53
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 6 · 2019: 2
- FWCI
- 0.55
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Current Pain and Headache Reports (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Center for Complementary and Integrative Health (K23AT009706)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- migraine, behavior therapy, medication adherence, cognitive behavioral therapy, biofeedback, progressive muscle relaxation, mobile health, adherence monitoring, email reminders, push notifications, patient engagement, headache frequency
- MeSH terms
- Wearable Electronic Devices, Feasibility Studies, Humans, Migraine Disorders, Patient Compliance, Cognitive Behavioral Therapy, Internet, Computers, Handheld
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