Impact of Behavioral Interventions on Migraine Treatment

Steven Baskin, PhD, explained how behavioral interventions can be used to manage migraine triggers, stressors, and psychiatric comorbidities, as well as maximize medication adherence and directly treat headache with relaxation based therapies, biofeedback, and cognitive-behavioral therapy, during a session at the 2018 Scottsdale Headache Symposium.

“Many often perceive psychological stress to be a headache trigger,” Dr Baskin said.

He explained that studies have demonstrated correlations between levels of daily stress as a trigger for migraine attacks. These attacks can happen during or follow stress. Further, he said there is evidence that validates the “let-down” headache following a stressful time period. 

“Stress-related factors may also progress episodic migraine to a more chronic state,” he said. “Other modifiable risk factors for progression to chronic migraine are high frequency of migraine, obesity, psychiatric comorbidities, medication and caffeine overuse, and snoring and sleep apnea.”

Dr Baskin explained that the factors leading to headache and migraine can all be helped by behavioral interventions.

He said for example, insomnia is often a problem in chronic migraine, but cognitive behavioral sleep therapies have been shown to reverse chronic migraine back to episodic migraine. 

He also said that medication adherence for migraine pharmacological treatment is usually low, and he explained that poor medication adherence can result in an ineffective treatment of acute attacks, medication overuse headache, greater risk of preventive medication side effects, and may be affected by psychiatric illness.

“Comprehensive behavioral treatments for migraine, as well as medication overuse headache, commonly incorporate education and motivation enhancement strategies to bolster preventive medication adherence and optimize acute care,” he said.

Dr Baskin then said that relaxation training, biofeedback training, and cognitive behavioral therapy have a good evidence base
and are often recommended for the prevention of migraine.

“Behavioral therapy outcomes rival outcomes with preventive medication alone with much less adverse events and combining behavioral treatments with preventive medication can enhance outcomes.”—Julie Gould