Nonpharmacological approaches in the management of recurrent headache disorders and their comparison and combination with pharmacotherapy

A comprehensive review of empirical findings from controlled studies of nonpharmacological treatments used either alone or in combination with pharmacological therapies for recurrent headache disorders is presented. Overall, the evidence support the value of approaches based on relaxation, biofeedback, and coping skills training. Their effects appear to be long-lasting and comparable to those obtained through the use of medications. The relative benefits, costs, and limitations of combining nonpharmacological and pharmacological treatments remain largely unknown. Efforts are being made to enhance the effectiveness of nonpharmacological interventions by focusing on subgroups of patients that have been identified as nonresponsive and learning how to tailor and combine treatment approaches. Progress in the understanding of the therapeutic mechanisms of nonpharmacological treatments remain rudimentary. Basic research is needed to shed light on the ways psychological and biological variables interact in producing migraines and tension-type headaches and to stimulate the development of more effective treatments. Clinical trials focusing on formats for treatment delivery have yielded encouraging results, but cost-benefit analyses are needed to address policy considerations for implementation of nonpharmacological treatments into mainstream health practice.