Half of Patients Referred for Behavioral Migraine Treatment Do Not Initiate Treatment

Less than one-third of eligible patients are referred for behavioral treatment for migraine, and only half of those referred initiate behavioral migraine treatment, according to a new study.

In addition to pharmacologic interventions to treat migraine, there are 3 types of behavioral headache treatments considered level A evidence-based: relaxation, biofeedback, and cognitive behavioral therapy.

“In addition to being effective (defined as resulting in at least a 50% reduction in headache days), these treatments are safe and well tolerated,” wrote the authors of the study. “Behavioral treatments have enduring benefits and may be less costly than pharmacologic interventions. However, suboptimal adherence may diminish the efficacy of these behavioral therapies.”

With this in mind, researchers sought to better understand factors related to initiation of behavioral migraine treatment following a physician recommendation. A total of 234 participants were recruited between July 19, 2016, and March 17, 2017. Referral to behavioral treatment was determined by a form in which the headache specialist marked down whether the patient was referred.

Of the 234 patients, 69 (29.5%) were referred for behavioral treatment, and of those, 53 completed a follow-up interview within 3 months of their initial appointment and were included in the analysis.

Researchers found that of the 53 patients, 30 (56.6%) initiated behavioral treatment. Those who had previously seen a psychologist were more likely to initiate therapy. Those who did not initiate behavioral treatment cited not having enough time, cost, skepticism that it would work, contentment with current treatment, and satisfaction that their headaches were already improving as reasons.

Reflecting on the results, the authors of the study wrote: “Behavioral treatments are associated with pain reduction, improvements in quality of life and medication adherence, and reduced psychiatric comorbidity. However, behavioral treatments are only effective when patients both initiate treatment and engage in the behavior change strategies recommended throughout treatment.”

They noted that those who did not initiate behavioral treatment did access other aspects of the health system. The majority (over 80%) had consulted with a primary care physician, over 40% had been to the emergency department for headaches, and over 40% had consulted with an ophthalmologist for their headaches.

The authors concluded by suggesting that further efforts to enhance access to behavioral treatments, such co-located and referral-based models, as well as efforts to enhance insurance reimbursement for these strategies, could be fruitful directions to improve migraine patient care.

Reference

Minen M, Azarchi S, Sobolev R, et al. Factors related to migraine patients' decisions to initiate behavioral migraine treatment following a headache specialist's recommendation: a prospective observational study [published online June 4, 2018]. Pain Med. doi: 10.1093/pm/pny028.