Non-pharmacological self-management for people living with migraine or tension-type headache: A systematic review including analysis of intervention components

摘要

ObjectivesTo assess the effect of non-pharmacological self-management interventions against usual care, and to explore different components and delivery methods within those interventionsParticipantsPeople living with migraine and/or tension-type headacheInterventionsNon-pharmacological educational or psychological self-management interventions; excluding biofeedback and physical therapy. We assessed the overall effectiveness against usual care on headache frequency, pain intensity, mood, headache related disability, quality of life, and medication consumption in meta-analysis. We also provide preliminary evidence on the effectiveness of intervention components and delivery methods.Results We found a small overall effect for the superiority of self-management interventions over usual care, with a SMD of-0.36 (-0.45 to -0.26) for pain intensity; -0.32 (-0.42 to -0.22) for headache related disability, 0.32 (0.20 to 0.45) for quality of life and a moderate effect on mood (SMD = 0.53 (-0.66 to -0.40)). We did not find an effect on headache frequency (SMD = -0.07 (-0.22 to 0.08). Assessment of components and characteristics suggests a larger effects on pain intensity in interventions that included explicit educational components (-0.51 (-0.68 to -0.34) versus -0.28 (-0.40 to -0.16)); mindfulness components (-0.50 (-0.82 to -0.18) versus 0.34 (-0.44 to -0.24) and in interventions delivered in groups versus one-to-one delivery (0.56 (-0.72 to -0.40) versus -0.39 (-0.52 to -0.27) and larger effects on mood in interventions including a CBT component with a SMD of -0.72 (-0.93 to -0.51) compared to those without CBT -0.41 (-0.58 to -0.24). Conclusion Overall we found that self-management interventions for migraine and tension-type headache are more effective than usual care in reducing pain intensity, mood, and headache related disability. Preliminary findings also suggest that including CBT, mindfulness and educational components in interventions, and delivery in groups may increase effectiveness.RegistrationPROSPERO 2016:CRD42016041291