Systematic review of cognitive behavioural therapy for the management of headaches and migraines in adults

Abstract

Aim: This systematic review aimed to establish if cognitive behavioural therapy (CBT) can reduce the
physical symptoms of chronic headache and migraines in adults.
Methods: Evidence from searches of eight databases was systematically sought, appraised and synthesised.
Screening of title and abstracts was conducted independently by two reviewers. Full papers were
screened, data extracted and quality assessed by one reviewer and checked by a second. Data were synthesised
narratively by intervention due to the heterogeneity of the studies. The inclusion criteria specified
randomised controlled trials with CBT as an intervention in adults suffering from chronic headaches/
migraines not associated with an underlying pathology/medication overuse. CBT was judged on the basis
of authors describing the intervention as CBT. The diagnosis of the condition had to be clinician verified.
Studies had to include a comparator and employ headache/migraine-specific outcomes such as patientreported
headache days.
Results: Out of 1126 screened titles and abstracts and 20 assessed full papers, 10 studies met the inclusion
criteria of the review. Some studies combined CBT with another intervention, as well as employing varying
numbers of comparators. CBT was statistically significantly more effective in improving some headachesrelated
outcomes in CBT comparisons with waiting lists (three studies), in combination with relaxation
compared with relaxation only (three studies) or antidepressant medication (one study), with no statistically
significant differences in three studies.
Conclusions: The findings of this review were mixed, with some studies providing evidence in support of
the suggestion that people experiencing headaches or migraines can benefit from CBT, and that CBT can
reduce the physical symptoms of headache and migraines. However, methodology inadequacies in the evidence
base make it difficult to draw any meaningful conclusions or to make any recommendations.

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