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The effectiveness of educational, behavioural, and cognitive self-management support interventions for chronic
Aiva Hailston1, Natasha Davies1, Mariam Ratna1
1Warwick Clinical Trials Unit, Warwick Medical School, https://ror.org/01a77tt86University of Warwick, Coventry, UK.
Aim:
In this systematic review, we identify and critically appraise randomised controlled trials of effectiveness of available educational, behavioural, cognitive, and self-management support interventions for individuals with chronic migraine.
Background:
Non-pharmacological interventions have the potential to help people living with chronic migraine. Little is known about their true effectiveness.
Methods:
We searched Cochrane, Embase, Medline, PsychINFO, Scopus, and Web of Science for randomised controlled trials assessing the effectiveness of educational, behavioural, cognitive, and self-management support interventions, compared to usual care, for adults with chronic migraine. Our outcomes of interest were headache frequency, headache-related disability, quality of life, pain intensity, medication consumption, and psychological wellbeing at baseline and follow-up.
Findings:
We included six randomised controlled trials (713 participants) whose interventions met our inclusion criteria: two educational, two psycho-educational, and two behavioural interventions. Trial heterogeneity precluded statistical pooling. Several small trials reported some between-group differences. One trial (N = 177) found more people had ≥50 reduction in headache frequency at 12 months following a psychological (mindfulness-based) intervention added to acute medication withdrawal in people with medication overuse headache: 43/89 (48%) control vs. 69/88 (78%) intervention, p < 0.001. However, the largest included study (N = 396) had effectively excluded the possibility that their intervention had a worthwhile effect on headache-related disability at 12 months; mean difference in Headache Impact Test (HIT-6) 0.7 (95% Confidence Interval -0.65 to 1.97). Current evidence does not support the use of educational, behavioural, cognitive, and self-management support interventions for individuals with chronic migraine to improve headache-related symptoms and quality of life. Very limited evidence suggests they may contribute towards headache frequency reduction.
