Psychological interventions for migraine

Migraine is a complex condition that imposes substantial epidemiological impact and social burden. In the past decade, innovative and targeted pharmacological preventive therapies have considerably improved the lives of people with migraine. A biopsychosocial model has been proposed to comprehensively explain migraine complexity, shedding light on the interconnections between emotional, psychological, social and biological factors, in contrast to a strict medical model. This modern view recognizes that relying solely on pharmacological treatment might not be sufficient, and that alternative treatment options, in particular, psychological ones, should be considered to help individuals manage the condition and enhance the effectiveness of medications. In this Review, we describe the most relevant psychological interventions for migraine, namely relaxation training, biofeedback, cognitive behavioural therapy, mindfulness, and acceptance and commitment therapy, as well as patient education as a first step of care. We discuss how these interventions can assist individuals throughout their treatment journey and consider possible mechanisms of action and barriers to their implementation. Last, we conclude by presenting the possibilities offered by digital health interventions.