Behavioral interventions for migraine prevention: A systematic review and meta-analysis

Area of Science:

• Neurology and Behavioral Medicine
• Evidence Synthesis and Systematic Review
• Clinical Trial Analysis

Background:

• Migraine prevention in children and adults lacks recent systematic reviews on behavioral interventions.
• Understanding the efficacy and safety of these non-pharmacological approaches is crucial for patient care.

Purpose of the Study:

• To synthesize existing evidence on the benefits and harms of behavioral interventions for migraine prevention.
• To evaluate the efficacy and safety of various behavioral therapies in reducing migraine frequency, disability, and improving quality of life.

Main Methods:

• Systematic literature search of randomized trials from 1975 to 2023 across multiple databases.
• Inclusion of trials on behavioral interventions for migraine prevention in children and adults.
• Data synthesis using meta-analysis where appropriate, with strength of evidence (SOE) rating.

Main Results:

• For adults, cognitive behavioral therapy (CBT), relaxation training, and mindfulness-based therapies showed low SOE for reducing migraine frequency.
• Education alone demonstrated low SOE for improving migraine-related disability in adults.
• For children/adolescents, CBT + biofeedback + relaxation training showed low SOE for reducing migraine frequency and disability compared to education alone.

Conclusions:

• Behavioral interventions, including CBT, relaxation, and mindfulness, show potential for migraine prevention in adults, while specific combinations show promise in children.
• The evidence base is limited by underpowered trials, high risk of bias, and inconsistencies in intervention components and reporting.
• Future research needs larger, well-designed trials with standardized components, appropriate control groups, and investigation of digital delivery methods.