Plain language summary
Non-pharmacological self-management interventions have been promoted as a promising approach for helping people with intractable chronic conditions. For migraine and tension type headaches self-management can be used either alongside pharmacological interventions or as a stand-alone therapy. The aims of this study were to provide an overall effect size of non-pharmacological self-management interventions against usual care, and to explore different components and delivery methods within those interventions. This study is a systematic review of 16 peer reviewed RCTs with one or more relevant self-management interventions compared with usual care. Findings indicate that non-pharmacological self-management appears to be slightly more effective in improving pain intensity, headache-related disability, quality of life and medication consumption. Furthermore, it is moderately more effective than usual care in improving mood. Assessed self-management interventions did not improve measures on headache frequency. Authors conclude that their findings provide some preliminarily evidence to guide research-based decisions about intervention content and delivery details of self-management interventions that aim to improve patients’ capacity to manage their headaches.
Abstract
OBJECTIVES To assess the effect of non-pharmacological self-management interventions against usual care, and to explore different components and delivery methods within those interventions PARTICIPANTS People living with migraine and/or tension-type headache INTERVENTIONS Non-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 standardised mean difference (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 effect on pain intensity in interventions that included explicit educational components (-0.51 (-0.68 to -0.34) vs -0.28 (-0.40 to -0.16)); mindfulness components (-0.50 (-0.82 to -0.18) vs 0.34 (-0.44 to -0.24)) and in interventions delivered in groups vs one-to-one delivery (0.56 (-0.72 to -0.40) vs -0.39 (-0.52 to -0.27)) and larger effects on mood in interventions including a cognitive-behavioural therapy (CBT) component with an SMD of -0.72 (-0.93 to -0.51) compared with 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, but have no effect on headache frequency. Preliminary findings also suggest that including CBT, mindfulness and educational components in interventions, and delivery in groups may increase effectiveness. TRIAL REGISTRATION NUMBER PROSPERO 2016:CRD42016041291.
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