From the Center for Sleep Evaluation, Elliot Hospital, Manchester and Department of Psychiatry, Dartmouth Medical Center, Lebanon, New Hampshire (Dr. Rains); Head Pain Center, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi (Dr. Penzien); Center for Clinical Health Policy Research, Duke University Medical Center, Durham, North Carolina (Drs. McCrory and Gray); and Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center Durham, North Carolina (Dr. McCrory).
Behavioral Headache Treatment: History, Review of the Empirical Literature, and Methodological Critique
Version of Record online: 25 MAY 2005
Headache: The Journal of Head and Face Pain
Volume 45, Issue Supplement s2, pages S92–S109, May 2005
How to Cite
Rains, J. C., Penzien, D. B., McCrory, D. C. and Gray, R. N. (2005), Behavioral Headache Treatment: History, Review of the Empirical Literature, and Methodological Critique. Headache: The Journal of Head and Face Pain, 45: S92–S109. doi: 10.1111/j.1526-4610.2005.4502003.x
- Issue online: 25 MAY 2005
- Version of Record online: 25 MAY 2005
- stress management;
Theoretical developments and burgeoning research on stress and illness in the mid-20th century yielded the foundations necessary to conceptualize headache as a psychophysiological disorder and eventually to develop and apply contemporary behavioral headache treatments. Over the past three decades, these behavioral headache treatments (relaxation training, biofeedback, cognitive-behavioral therapy, and stress-management training) have amassed a sizeable evidence base. Meta-analytic reviews of the literature consistently have shown behavioral interventions to yield 35% to 55% improvements in migraine and tension-type headache and that these outcomes are significantly superior to control conditions. The strength of the evidence has lead many professional practice organizations to recommend use of behavioral headache treatments alongside pharmacologic treatments for primary headache. The present overview was prepared as a companion article to and intended to provide a background for the Guidelines for Trials of Behavioral Treatments for Recurrent Headache also published within this journal supplement. This article begins with a synopsis of key historical developments leading to our current conceptualization of migraine and tension-type headache as psychophysiological disorders amenable to behavioral intervention. The evolution of the behavioral headache literature is discussed, exemplified by publication trends in the journal Headache. Leading empirically-based behavioral headache interventions are described, and meta-analytic reviews examining the migraine and tension-type headache literatures are summarized, compared, and contrasted. A critique of the methodological quality of the clinical trials literature is presented, highlighting the strengths and weaknesses in relation to recruitment and selection of patients, sample size and statistical power, the use of a credible control, and the reproducibility of the study interventions in clinical practice.