Psychological interventions for migraine: a systematic review

Migraine causes major health impairment and
disability. Psychological interventions offer an addition to
pharmacotherapy but they are not currently recommended
by the National Institute of Clinical Excellence (NICE) or
available in the National Health Service. We aimed to
systematically review evidence on the efficacy of psychological
interventions for migraine in adults. A search was
done of MEDLINE, psychINFO, http://www.opengrey.eu,
the meta-register of controlled trials and bibliographies.
Twenty-four papers were included and rated independently
by two people using the Yates scale, which has 35 points.
Cochrane recommendations are that high quality reports
score above the mid-point (18 points). Methods used in
17/24 papers were rated ‘high quality’. However, frequently
descriptions of key areas such as randomisation
methods were omitted. Eighteen studies measured effects
of psychological interventions on headache-related outcomes,
fifteen reporting significant improvements, ranging
20–67 %. Interventions also produced improvements in
psychological outcomes. Few trials measured or reported
improvement in disability or quality of life. We conclude
that evidence supports the efficacy of psychological interventions
in migraine. Over half of the studies were from
the USA, which did not provide universal health care at the
time of the study, so it is difficult to generalise results to
typical populations in receipt of publically funded health
services. We agree with the NICE recommendation that
high quality pragmatic randomised controlled trials are
needed in the UK.