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Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components

Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components
Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components

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.

Affect, Analgesics/administration & dosage, Chronic Pain/therapy, Cognitive Behavioral Therapy, Headache/therapy, Humans, Migraine Disorders/therapy, Mindfulness, Pain Management/methods, Patient Education as Topic, Psychotherapy, Group, Quality of Life, Self-Management, Tension-Type Headache/therapy
2044-6055
Probyn, Katrin
2604caf4-b2bf-4f9e-a19f-16046cb6e4e4
Bowers, Hannah
c81d418d-3cd7-4da5-bd09-0eee862bd49f
Mistry, Dipesh
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Caldwell, Fiona
fe85b24d-112e-46bc-a1f3-efdd267d6d92
Underwood, Martin
239a8609-e7b5-4acb-aaf9-9e7f717f0d62
Patel, Shilpa
c03f9949-cb98-4a60-b061-a211d474b7db
Sandhu, Harbinder Kaur
b58b0cec-4f88-4ce1-9841-20a39a0f6fdd
Matharu, Manjit
fce89299-8b6c-403e-8835-565eecc61b8b
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
CHESS team.
Probyn, Katrin
2604caf4-b2bf-4f9e-a19f-16046cb6e4e4
Bowers, Hannah
c81d418d-3cd7-4da5-bd09-0eee862bd49f
Mistry, Dipesh
a8bdb6a9-78fd-429e-b7c5-7a4aa3fd5ab6
Caldwell, Fiona
fe85b24d-112e-46bc-a1f3-efdd267d6d92
Underwood, Martin
239a8609-e7b5-4acb-aaf9-9e7f717f0d62
Patel, Shilpa
c03f9949-cb98-4a60-b061-a211d474b7db
Sandhu, Harbinder Kaur
b58b0cec-4f88-4ce1-9841-20a39a0f6fdd
Matharu, Manjit
fce89299-8b6c-403e-8835-565eecc61b8b
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c

Probyn, Katrin, Bowers, Hannah, Mistry, Dipesh, Caldwell, Fiona, Underwood, Martin, Patel, Shilpa, Sandhu, Harbinder Kaur, Matharu, Manjit and Pincus, Tamar , CHESS team. (2017) Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components. BMJ Open, 7 (8), [e016670]. (doi:10.1136/bmjopen-2017-016670).

Record type: Review

Abstract

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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Accepted/In Press date: 21 June 2017
Published date: 11 August 2017
Keywords: Affect, Analgesics/administration & dosage, Chronic Pain/therapy, Cognitive Behavioral Therapy, Headache/therapy, Humans, Migraine Disorders/therapy, Mindfulness, Pain Management/methods, Patient Education as Topic, Psychotherapy, Group, Quality of Life, Self-Management, Tension-Type Headache/therapy

Identifiers

Local EPrints ID: 455418
URI: http://eprints.soton.ac.uk/id/eprint/455418
ISSN: 2044-6055
PURE UUID: 28b37672-1d0e-408e-be97-21c0f0e1153f
ORCID for Tamar Pincus: ORCID iD orcid.org/0000-0002-3172-5624

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Date deposited: 21 Mar 2022 17:45
Last modified: 19 Nov 2022 02:58

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Contributors

Author: Katrin Probyn
Author: Hannah Bowers
Author: Dipesh Mistry
Author: Fiona Caldwell
Author: Martin Underwood
Author: Shilpa Patel
Author: Harbinder Kaur Sandhu
Author: Manjit Matharu
Author: Tamar Pincus ORCID iD
Corporate Author: CHESS team.

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