Efficacy of psychological treatment for headache disorder: a systematic review and meta-analysis.
BACKGROUND
Headache disorder is not only a common complaint but also a global burden. Pharmacotherapeutic and non-pharmacotherapeutic approaches have been developed for its treatment and prophylaxis. The present study included a systematic review of psychological treatments for primary headache disorder accessible in Korea.


METHODS
We included English and Korean articles from EMBASE, MEDLINE, Cochrane library database, SCOPUS, ScienceDirect, Web of Science, CINAHL, PsycArticles and Korean database, KoreaMed and KMBASE which studied primary headache and medication-overuse headache. The primary efficacy measure was the number of headache days per month, while secondary efficacy measures were the number of headache attacks per week, headache index, treatment response rate, and migraine disability assessment. The meta-analysis was performed using R 3.5.1. to obtain pooled mean difference and pooled relative risk with 95% confidence interval (CI) for continuous data and dichotomous data, respectively.


RESULTS
From 12,773 identified articles, 27 randomized clinical trials were identified. Primary outcome showed significant superiority of psychological treatments (pooled mean difference = - 0.70, 95% CI [- 1.22, - 0.18]). For the secondary outcomes, the number of headache attacks (pooled mean difference = - 1.15, 95% CI [- 1.63, - 0.67]), the headache index (pooled mean difference = - 0.92, 95% CI [- 1.40 to - 0.44]) and the treatment response rate (pooled relative risk = 3.13, 95% CI [2.24, 4.37]) demonstrated significant improvements in the psychological treatment group over the control group.


CONCLUSION
Psychological treatments for primary headache disorder reduced headache frequency and the headache index. Future research using standardized outcome measures and strategies for reducing bias is needed.
['Lee|Hye Jeong|HJ|', 'Lee|Jin Hyeok|JH|', 'Cho|Eun Young|EY|', 'Kim|Sun Mi|SM|', 'Yoon|Seoyoung|S|http://orcid.org/0000-0003-1845-7722']
D051270:Headache Disorders, Primary D006801:Humans D011613:Psychotherapy D016032:Randomized Controlled Trials as Topic D016896:Treatment Outcome
Headache disorders Meta-analysis Abbreviations BFT biofeedback Behavior therapy Biofeedback CBT Cognitive behavior therapy Cognitive therapy MBT mindfulness-based treatment RCTs, randomized controlled trials MIDAS, migraine disability assessment Mindfulness NICE National Institute for Health and Care Excellence SD standard deviations RR, relative risk