Mediating factors in non-medical treatment for migraine headache: toward an interactional model

The inadequacy of traditional (i.e. pharmacological) treatment for migraine headache has led to the development of numerous non-medical interventions (e.g. biofeedback, relaxation, cognitive-behavioral programs). All of these non-medical interventions have produced at least some success in reducing migraine headache parameters. However the mechanism of treatment efficacy is unclear, with a number of not mutually exclusive relationships proposed. Purported mediators of successful outcome in these treatments include specific control of vascular activity, general reduction of autonomic arousal, biochemical changes, cognitive, affective, and behavioral change, therapist contact and support, and credibility and placebo expectancy. The present paper attempts to discuss and evaluate the mechanisms of change that have been proposed as mediators of successful treatment of migraine headache. An interactional model of adaptive change as a function of treatment is presented. The implications of the model for assessment and treatment are discussed. It is suggested that the interactional model may be applicable to the treatment of a range of chronic pain problems.