Efficacy of psychological treatment for headaches: An overview of systematic reviews and analysis of potential modifiers of treatment efficacy

Objectives: A variety of psychological treatments exist for headaches (HAs). Their efficacy has been evaluated through systematic reviews with meta-analysis. Our goal was to evaluate the scope of these reviews and reevaluate the efficacy of treatments considering potential sources of variation systematically. These findings should help guide clinical practice and will provide guidance to researchers planning to address the efficacy of psychological treatments for HAs. Materials and methods: Two systematic reviews were conducted: one searched for systematic reviews with meta-analysis exploring the efficacy of psychological treatments for HA in Cochrane Database, DARE, EMBASE, ISI Web of Knowledge, Medline, and PsychINFO from inception to December 2011. Two independent reviewers screened, evaluated quality, and extracted data. The second review searched for primary studies from the included reviews estimating the efficacy of psychological treatments for a clinically significant change. Results: Eighteen reviews met a priori criteria for inclusion. The broad scope of research on efficacy of psychological treatments for HA is reflected by variation in clinical and methodological characteristics of the reviews. These variations were explored through meta-analysis and subgroup analysis of 41 primary studies and showed that some of these variations, including time of assessment, treatment type, age, HA diagnosis, and study quality, can impact the magnitude of treatment effect. Discussion: There is substantial evidence in favor of psychological treatments for HA management. Further investigation, especially in specific treatments (cognitive-behavioral or autogenic treatment) for HA disorders, is needed. The assessment of these systematic reviews highlighted key areas where improvement should be made to increase the quality of evidence.