Behavioral treatment strategies for migraine and tension-type headache: a review of the evidence and future directions.

Behavioral treatments have become widely accepted interventions for migraine and tension-type headache. Ample empirical evidence supports the effectiveness of interventions, such as relaxation training, biofeedback and cognitive-behavioral (i.e., stress-management) treatments. Such interventions may be utilized alone or in combination with the more widely used pharmacological treatments for headache. Behavioral approaches are often the treatments of choice for patients who have contraindications to or who are refractory to traditional pharmacologic interventions. Recent research has attempted to increase the availability of behavioral treatments to patients through more cost-effective forms of treatment administration. Ample empirical evidence now indicates that these efficient interventions are just as effective as more time-intensive, individually administered clinic-based treatments. Important future directions for behavioral headache treatments include: integration into the primary care setting, developing algorithms for matching behavioral and pharmacologic treatments to patient characteristics for maximum effectiveness, behavioral skills training to enhance outcomes with pharmacologic interventions and reduce complications (e.g., rebound migraine), as well as identifying and treating comorbid conditions that undermine treatment.