Behavioral Treatment for Migraine Headaches

A recently study titled Direct Costs of Preventive Headache Treatments: Comparison of Behavioral and Pharmacologic Approaches appearing in Headache: The Journal of Head and Face Pain, 51 (6): 985 -991, June 2011, and written by Allison M. Shafer et al., finds that treating chronic migraines using inexpensive prophylactic medicines such as beta-blockers or tricyclic antidepressants and behavioral approaches such as relaxation training, biofeedback, cognitive behavioral therapy, and stress management are a low cost and effective treatment option particularly after 1 year of treatment.

The authors used a cost minimization analysis and found that after 1 year, the cost of minimal-contact behavioral treatment was cheaper than the least expensive headache treatment medications. Minimal-contact or home based intervention is when a patient sees a therapist for around 3 or 4 visits and  largely practices the behavioral techniques at home through the use of printed materials and audio recordings.

For those who would prefer more visits with a therapist the researchers also found that clinic-based behavioral treatment where a therapist is seen in 8 to 12 weekly sessions becomes cost competitive with medications within 6 months and cheaper than most of the medications available for headache prevention within 1 year.

The study concludes

“While behavioral interventions for headache have been well validated empirically and have garnered increasing acceptance in recent years, these therapeutic modalities are not widely integrated into the clinical management of headache patients. Broadscale integration into mainstream healthcare practice depends greatly upon more systematically addressing access as well as financial and reimbursement barriers associated with this valuable approach to care.”

Of course if money is not much of an issue it may be best to pursue all available options. However, this study is important to help save costs for those in need (and also the entire health system). I personally have experience with behavioral approaches for the treatment of my chronic headache brought on by having my 4 healthy wisdom teeth extracted as discussed on  I also have discussed medications I have tried as well. I hope that behavioral approaches for the management of headaches becomes more widely used and may be very useful and cheaper for some.

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