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Behavioral Therapies Are Underused in Migraine Treatment

Behavioral treatments for migraine, including biofeedback and relaxation training, are often helpful in the treatment of migraine, but most healthcare professionals do not suggest these options or refer people for treatment.

According to a study presented at the American Headache Society conference last month, less than 25% of migraine specialists refer patients for non-drug treatment of migraine, despite the fact that behavioral treatments have a “Grade A” effectiveness rating. This rating means the benefits of the treatment outweigh any potential risks.

Lead author of the study, Robert A. Nicholson, PhD, of Mercy Health Research in Saint Louis, offered possible explanations for this finding. “Reasons may include both a lack of knowledge about the value of such treatment as much as a lack of available referral services in local communities,” he said.

For the study, researchers surveyed members of the American Headache Society to determine their beliefs and use of behavioral treatments. Migraine specialists who are also mental health professionals are the most likely to refer patients for behavioral treatment, Nicholson noted, with stress management, relaxation training and psychotherapy being the most common reason for referral. Also significant, he said, is that while two-thirds of specialists routinely assess patients for depression and more than half assess for anxiety–both of which are often associated with migraine–only 30% of headache specialists reported assessing patients for abuse and post-traumatic stress disorder, which are also associated with migraine.

Previous research has also found economic benefits of behavioral therapies. In June 2011, the journalHeadache published a study indicating that behavioral therapies can be a cheaper and long-lasting alternative to medication. After a year, the study found, therapies that required minimal contact with a healthcare professional were $500 cheaper than drug therapies.

At the National Headache Foundation, founder and executive chairman Seymour Diamond, MD, also believes this issue is important and noted his own success with biofeedback. Since 1972, I used biofeedback as an effective adjunctive therapy with patients with simple headache histories, as well as those who had long-term headache experiences and were refractory to other therapies,” he said.

He noted that at the Diamond Headache Clinic, the use of biofeedback in children with headaches proved very useful.

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