Study Demonstrates Feasibility of Migraine-Specific CBT

Researchers in Germany showed that targeted behavioral therapies may benefit patients with migraine. Katherine Hamilton, MD, of the University of Pennsylvania, weighs-in on the results of the research.

A new study published in Headache: The Journal of Head and Face Pain® demonstrated the feasibility of developing a cognitive behavioral therapy program specifically for migraine patients, according to Katherine Hamilton, MD, of the University of Pennsylvania.

“It’s a first step to ultimately figuring out whether this is something that’s effective and can be incorporated into headache practice,” says Dr. Hamilton, who was not affiliated with the research.

Hamilton notes that some studies on various behavioral therapies for migraine have been conducted before, but highlights a lack of standardization across the studies and the presence of mixed results. She says that, based on what the study’s authors proposed, this is really the first behavioral treatment developed specifically for migraine patients, as opposed to leveraging various therapies that exist and applying them to migraine patients.

“So that’s what makes this novel: instead of just applying these general behavioral techniques for migraine patients, it’s really developing a specific migraine program that could potentially allow for more uniform treatment of migraine patients and let this be studied in a more uniform manner,” Dr. Hamilton says.

The Study

Dr. Timo Klan of the University of Mainz in Germany and colleagues set out to present a novel cognitive behavioral therapy program developed exclusively for adult patients with migraine and assess its feasibility. Unlike previous efforts, researchers combined different behavioral therapies into one program, leveraging relaxation therapy, cognitive behavioral therapy and trigger management.


The single-group study utilized a treatment program that consisted of 7 sessions, including psychoeducation, lifestyle counseling, coping with the fear of migraine attacks, trigger management, and stress management. Nine research participants—8 female subjects and 1 male—were evaluated, 5 of whom had migraine without aura, 2 of whom had migraine with aura and 2 of whom had chronic migraine. After each group therapy session, evaluation questionnaires were filled out, with individual qualitative interviews were conducted after the program was completed.

Results and Conclusions

Researchers found the treatment program to be very well accepted. All sessions were rated as comprehensible, with a high overall satisfaction reported for the sessions. It was noted that participants greatly appreciated the access to a specific treatment that exclusively addressed migraine.

Dr. Klan and colleagues concluded that the idea of combining several behavioral therapy approaches into a specific treatment program for migraine appeared feasible and promising. A randomized, controlled trial is currently being carried out to determine the efficacy of the program.


Dr. Hamilton notes that it is sometimes hard for practitioners to translate how this kind of research would be useful in the practice. She specifically points out that the study took place in Germany, which has a healthcare system that varies greatly from the one found in the U.S. This means that the kinds of interventions that can be implemented abroad may not be as easy to leverage here.

She also says the results were not very surprising, and that the conclusion “intuitively makes sense” based on what is known about the effectiveness of behavioral therapy and biofeedback on migraine. She highlights, however, that the number of participants was low, and that not much can truly be concluded from the results in terms of the patients’ improvement levels.

“It really couldn’t show anything about actual efficacy and if patients had shown improvement in various measures, including headache frequency, headache severity, quality of life, etc.,” Dr. Hamilton says. “Now they really have to do much larger studies with more patients to show that this program is actually effective in helping with their migraine and their quality of life.”

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