Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components
Open accessAbstract
OBJECTIVES: To assess the effect of non-pharmacological self-management interventions against usual care, and to explore different components and delivery methods within those interventions PARTICIPANTS: People living with migraine and/or tension-type headache INTERVENTIONS: Non-pharmacological educational or psychological self-management interventions; excluding biofeedback and physical therapy.We assessed the overall effectiveness against usual care on headache frequency, pain intensity, mood, headache-related disability, quality of life and medication consumption in meta-analysis.We also provide preliminary evidence on the effectiveness of intervention components and delivery methods. RESULTS: We found a small overall effect for the superiority of self-management interventions over usual care, with a standardised 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)). We did not find an effect 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-behavioural therapy (CBT) component with an SMD of -0.72 (-0.93 to -0.51) compared with those without CBT -0.41 (-0.58 to -0.24). CONCLUSION: Overall we found that 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. Preliminary findings also suggest that including CBT, mindfulness and educational components in interventions, and delivery in groups may increase effectiveness. TRIAL REGISTRATION NUMBER: PROSPERO 2016:CRD42016041291.
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For people living with chronic migraine or chronic tension type headache, non-pharmacological self-management approaches may improve headache-related symptoms while not affecting headache frequency.
“For people living with chronic migraine or chronic tension type headache, non-pharmacological self-management approaches may improve headache-related symptoms while not affecting headache frequency.14”
From Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: A randomised controlled trial protocol (CHESS) (2020) · cites this paper as [14]
The Discussion (Findings and implications; page unavailable) reports improvements in pain intensity and headache-related disability, but no improvement in headache frequency. However, the Methods (Study population) include both chronic and episodic headache, and the Discussion (Strengths and limitations) says the groups could not be analysed separately. The results therefore do not establish the stated pattern specifically for people with chronic migraine or chronic tension-type headache. (LLM, conf=0.88)
Experimental — accuracy not yet measuredGroup interventions using a cognitive behavioural approach, mindfulness and educational components may be more effective than alternative interventions.
“Group interventions using a cognitive behavioural approach, mindfulness and educational components may be more effective than alternative interventions.14”
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Self-citation
- Authors
- Probyn, K., Bowers, H., Mistry, D., Caldwell, F., Underwood, M., Patel, S., Sandhu, H. K., Matharu, M., & Pincus, T.
- Affiliations
- Royal Holloway University of London (GB)
- University of Warwick (GB)
- National Hospital for Neurology and Neurosurgery (GB)
- Corresponding author
- Probyn, Katrin
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-08
- Volume
- 7
- Issue
- 8
- Pages
- e016670
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5629643
- OpenAlex
- W2743939179
- Cited by
- 149
- References
- 44
- Citations by year
- 2026: 12 · 2025: 21 · 2024: 15 · 2023: 17 · 2022: 27 · 2021: 22 · 2020: 13 · 2019: 13 · 2018: 7 · 2017: 1 · 2016: 1
- FWCI
- 1.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Programme Grants for Applied Research
- 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, tension-type headache, self-management interventions, non-pharmacological treatment, pain intensity, headache-related disability, quality of life, mood, cognitive behavioral therapy, mindfulness, educational intervention, intervention components, medication consumption, headache frequency, usual care comparison, intervention delivery methods, intervention characteristics, intervention moderators
- MeSH terms
- Self-Management, Affect, Analgesics, Headache, Humans, Migraine Disorders, Patient Education as Topic, Psychotherapy, Group, Quality of Life, Cognitive Behavioral Therapy, Tension-Type Headache, Chronic Pain, Pain Management, Mindfulness
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