The Migraine Treatment No One is Suggesting

Behavioral therapy is key migraine treatment but remains underused

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Despite demonstrated evidence-based effectiveness, a new survey revealed that few migraine treatment specialists suggest that their patients try biofeedback, cognitive behavioral therapy or relaxation training.

With the exception of psychologists, most migraine specialists also were unaware that the treatments are considered validated "Grade A" therapies.

"Ask your doctor if behavioral therapy would be beneficial."

Robert A. Nicholson, PhD, lead author of the study from Mercy Health Research, said that the web survey revealed low referral rates for behavioral therapies. He said the treatments were underutilized because of a lack of knowledge about their value and because there are few available referral services in some local communities.

During the study, 784 American Headache Society members were asked to complete a questionnaire regarding frequency and methods of assessing psychological conditions that also could be present in migraine sufferers, referral habits and their perceptions of patients best suited for behavioral treatment.

Of the 61 individuals who responded, most were doctors. About 11 percent were nurses or nurse practitioners and 13 percent were psychologists or mental health professionals.

Of those, 75 percent of psychologists knew that biofeedback was an evidence-backed treatment compared to only 29 percent of physicians and 43 percent of nurses.

In addition 88 percent of psychologists were aware cognitive behavioral therapy was "Grade A" versus 22 percent of doctors and 14 percent of nurses, while 75 percent of psychologists, 13 percent of doctors and 14 percent of nurses were aware that relaxation therapy could aid migraine patients.

The overall referral rate for non-medication treatment was 20 percent with stress management, relaxation training, and psychotherapy being the most common reasons for referral.

Health professional were most likely to refer patients for behavioral therapy if they had difficulty coping with headache-related disability, experienced anxiety, or had trouble managing stress or migraine triggers.

Researchers found that two-thirds of specialists routinely assess patients for depression, and over half assess for anxiety, but fewer than a third assess for abuse or post-traumatic stress disorder, which also are associated with migraines.

They said that the findings indicate a clear need to educate about evidence supporting the role and effectiveness of behavioral therapy in migraine care.

The study was recently presented at the American Headache Society’s 54th Annual Scientific Sessions in Los Angeles, Calif.

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Review Date: 
June 25, 2012
Last Updated:
June 29, 2012