Behavioral therapy in migraine: Expanding the therapeutic arsenal

• Published in: European journal of neurology 2024-12, Vol.31 (12), p.e16414-n/a
• Main Authors: Mínguez‐Olaondo, Ane, Días, Patricia Alves, Munáin, Estibaliz López, Grozeva, Vesselina, Laspra‐Solís, Carmen, Villalba, Inés Martín, García‐Martín, Valvanuz, Vila‐Pueyo, Marta, Barandiarán, Myriam, Zabalza, Ramon J., Bengoetxea, Ana
• Format: Article
• Language: English
• Subjects: Behavior therapy; Behavior Therapy - methods; behavioral; disability; Disease management; Effectiveness; Empowerment; Headache; Headaches; Humans; Immunological tolerance; Information management; Information retrieval; management; Migraine; Migraine Disorders - therapy; Pain; Pain perception; Prophylaxis; Review; Sympathetic nervous system; Therapy
• ISSN: 1351-5101; 1468-1331; 1468-1331
• DOI: 10.1111/ene.16414

Background and purpose The US Headache Consortium developed evidence‐based guidelines for the treatment of migraine and found grade A evidence in support of behavior therapy (BT). Understanding the mechanisms of BT may improve the management of migraine and reduce its burden. Methods We performed a narrative review to define the current evidence of BT and determine its usefulness in migraine management. Results The information was obtained from 116 publications, with 56 of them retrieved through direct searches in PubMed (2011–2020) and the remainder selected by the authors to complete the content. BT might reduce migraine impact by decreasing the sympathetic nervous system's response to stress and increasing pain tolerance. Acting in headache‐related surroundings can be improved, together with headache duration and self‐efficacy. Applications such as mobile health and electronic health applications can help to carry out healthier lifestyle patterns. Regarding medication overuse, BT seems to be a good choice, with similar results to pharmacological prophylaxis. Advantages of using BT are the lack of adverse effects and the unrestricted use in children, where BT is postulated to be even more effective than the standardized pharmacopeia. Conclusions BT is an interesting tool that can be used as an add‐on therapy in migraine. Through BT, the autonomy and empowerment of migraine patients is enhanced. BT may not cure migraine, but it could help to reduce pain severity perception, disability, and migraine impact, adding an emotive and cognitive approach to the perceptive role of pharmacopeia. Thus, a better approach in migraine, implementing specific therapeutic management, can improve migraine control. Behavior therapy is a useful tool with long‐lasting value. Long‐term migraine treatment should focus on adherence to therapy as well as on medical information and lifestyle modification options. Data from this study encourage the incorporation of nonpharmacological interventions in migraine treatment and the investigation of these techniques to profile the patient features for which each evaluated technique may be more suitable and thus to obtain a greater return on the investment made while working on it.