Migraine causes major health impairment and disability costing the UK over £2 billion annually. Psychological interventions offer an addition to pharmacotherapy, but are not currently available in the NHS. We aimed to systematically review evidence on the efficacy of psychological interventions for migraine in adults published since 1999, when the last systematic review was published.
A search was done of MEDLINE and psychINFO, as well as www.opengrey.eu, the metaregister of controlled trials and bibliographies. 24 papers were included and rated independently by two people using the Yates scale, which has 35 points. Cochrane recommendations are that high quality reports score above the mid-point.
Methods used in 17/24 papers were rated ‘high quality’. However, frequently descriptions of key areas such as randomisation methods were omitted. 20 papers measured effects of psychological interventions on headache-related outcomes, 16 reporting significant improvements, ranging 20–68%. The interventions also produced improvements in psychological outcomes. Few trials reported measuring and finding improvement in disability and quality of life.
We conclude that evidence since 1999 supports the efficacy of psychological interventions in migraine, but most is from the USA. We agree with the NICE recommendation that high quality pragmatic randomized controlled trials are now needed in the UK.