Behavioral Migraine Management Modifies Behavioral and Cognitive Coping in People With Migraine


  • Conflict of Interest: Dr. Seng has no conflicts to report. Dr. Holroyd has received funding from the National Institutes of Health and an investigator-initiated grant from Endo Pharmaceuticals. Dr. Holroyd has full control of all primary data from the TSM trial. All analyses were conducted by Dr. Seng.
  • Support for this trial was provided by grant NS-32374 (awarded to Dr. Holroyd) from the National Institutes of Health. Merck Pharmaceuticals, Inc and GlaxoSmithKline Pharmaceuticals donated triptans (5-HT1B/D-agonists) for acute migraine therapy, which was their only involvement.



This is a secondary analysis of a randomized clinical trial which aims to examine changes in cognitive and behavioral responses to migraine with cognitive behavioral treatment for migraine, preventive medication for migraine, and their combination, and the relationship between these changes and reductions in migraine-related disability.


Cognitive behavioral treatment is thought to reduce migraine-related disability through modifying maladaptive cognitive and behavioral responses to migraine.


Two hundred thirty-two people with migraine who did not respond to 5 weeks of optimized acute therapy were randomized into a 2 (beta-blocker vs placebo) X 2 (behavioral migraine management [BMM] vs no BMM) treatment design. Participants received BMM and/or beta-blocker dose adjustment for 4 months, and were followed for an additional 12 months. Participants completed measures of catastrophizing, behavioral coping, and migraine-related disability throughout the study.


Compared to drug therapy only, BMM demonstrated larger decreases in catastrophizing scores (19.16 to 9.89 vs 16.78 to 11.84, P < .001) and increases in number of positive coping strategies (proactive: 1.09 to 1.90 vs 1.16 to 1.09, P  < .001; anticipatory: 0.19 to 0.69 vs 0.10 to 0.08, P  < .001; migraine management: 0.14 to 0.36 vs 0.04 to 0.04, P  < .001) at the end of the follow-up period. Decreases in catastrophizing were associated with a larger BMM effect on migraine-related disability (P = .036).


This study demonstrated that BMM modified important cognitive and behavioral factors postulated to be mechanisms of cognitive behavioral treatments for migraine.