CBT for migraine

In April 2017, Lucina reported on evidence that most of the apparent effectiveness of drugs used for migraine prevention is probably placebo effect (doi.org/10.1136/archdischild-2017– 3 12 882). Wouldn’t it be good if there was a treatment that was highly effective in the real world, whether through placebo effect or not, without any risk of drug side-effects? Well there is, according to a systematic review and meta-analysis (Ng QX, et al; Headache 2017 doi: doi.org/10.1111/head.13016). The Singaporean authors looked for trials investigating cognitive behavioural therapy (CBT) in childhood migraine and/or headache. They found 14 studies which could be meta-analysed. All were randomised controlled trials, but by their nature they could not be double-blind. Control interventions varied: some received drugs, some non-drug support, and some nothing. All used headache frequency as the primary outcome. The meta-analysis conclusion was striking: the odds of a reduction in headache frequency of 50% or more immediately following treatment was 9 times greater in those who received …