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

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 educa...

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Autores principales: Probyn, Katrin, Bowers, Hannah, Mistry, Dipesh, Caldwell, Fiona, Underwood, Martin, Patel, Shilpa, Sandhu, Harbinder Kaur, Matharu, Manjit, Pincus, Tamar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629643/
https://www.ncbi.nlm.nih.gov/pubmed/28801425
http://dx.doi.org/10.1136/bmjopen-2017-016670
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author Probyn, Katrin
Bowers, Hannah
Mistry, Dipesh
Caldwell, Fiona
Underwood, Martin
Patel, Shilpa
Sandhu, Harbinder Kaur
Matharu, Manjit
Pincus, Tamar
author_facet Probyn, Katrin
Bowers, Hannah
Mistry, Dipesh
Caldwell, Fiona
Underwood, Martin
Patel, Shilpa
Sandhu, Harbinder Kaur
Matharu, Manjit
Pincus, Tamar
author_sort Probyn, Katrin
collection PubMed
description 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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spelling pubmed-56296432017-10-11 Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components Probyn, Katrin Bowers, Hannah Mistry, Dipesh Caldwell, Fiona Underwood, Martin Patel, Shilpa Sandhu, Harbinder Kaur Matharu, Manjit Pincus, Tamar BMJ Open Patient-Centred Medicine 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 BMJ Publishing Group 2017-08-11 /pmc/articles/PMC5629643/ /pubmed/28801425 http://dx.doi.org/10.1136/bmjopen-2017-016670 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Patient-Centred Medicine
Probyn, Katrin
Bowers, Hannah
Mistry, Dipesh
Caldwell, Fiona
Underwood, Martin
Patel, Shilpa
Sandhu, Harbinder Kaur
Matharu, Manjit
Pincus, Tamar
Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components
title Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components
title_full Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components
title_fullStr Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components
title_full_unstemmed Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components
title_short Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components
title_sort non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components
topic Patient-Centred Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629643/
https://www.ncbi.nlm.nih.gov/pubmed/28801425
http://dx.doi.org/10.1136/bmjopen-2017-016670
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