NONPHARMACOLOGICAL APPROACHES IN THE MANAGEMENT OF RECURRENT HEADACHEDISORDERS AND THEIR COMPARISON AND COMBINATION WITH PHARMACOTHERAPY

A comprehensive review of empirical findings from controlled studies o f nonpharmacological treatments used either alone or in combination wi th pharmacological therapies for recurrent headache disorders is prese nted. Overall, the evidence support the value of approaches based on r elaxation, biofeedback, and coping skills training Their effects appea r to be long-lasting and comparable to those obtained through the use of medications. The relative benefits, costs, and limitations of combi ning nonpharmacological and pharmacological treatments remain largely unknown. Efforts are being made to enhance the effectiveness of nonpha rmacological interventions by focusing on subgroups of patients that h ave been identified as nonresponsive and learning how to tailor and co mbine treatment approaches. Progress in the understanding of the thera peutic 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 treatment s. Clinical trials focusing on formats for treatment delivery have yie lded encouraging results, but cost-benefit analyses are needed to addr ess policy considerations for implementation of nonpharmacological tre atments into mainstream health practice. Copyright (C) 1996 Elsevier S cience Ltd