Non-pharmacological treatment of headache: is less more?

A twenty-six article review of the literature pertaining to non-pharmacological treatment of headache was undertaken. The data supports no significant difference in the efficacy of hypnosis, biofeedback and relaxation training. These studies demonstrated no relationship between hypnotizability or capacity for temperature elevation and headache improvement. The literature reviewed suggests the mechanism for improvement with non-pharmacological treatment may be physiologically nonspecific, with patient age, perceived locus of control and motivation likely to predict successful treatment. Home-based, minimal therapist contact, biofeedback and relaxation treatment appear to work as effectively as intensive clinic-based treatment.