A wide range of nonpharmacological interventions may be effective for pediatric migraine, a systematic review and meta-analysis suggests. Researchers examined data from 12 randomized controlled trials that included 576 children and adolescents with migraine who received interventions such as self-administered treatments, biofeedback, relaxation, and psychological therapy, or who joined control groups that received psychological placebo or sham biofeedback or waiting list placement for other interventions. The primary endpoint was the effect size of intervention efficacy, calculated as standard mean differences (SMD). All the tested interventions were more effective than the waiting list when researchers examined groups with similar types of interventions, the analysis found. Effect sizes varied, with the smallest effect seen for long-term psychological placebos (SMD 1.14) and the largest seen for short-term self-administered treatments (SMD 1.44). When researchers examined each intervention individually, however, none of them was significantly more effective than controls, the authors report in Pediatrics. It's likely that the analysis was underpowered to identify statistically significant results, the study team notes. "Clinically, our results reveal that relaxation, biofeedback, psychological treatments, and self- administered psychological treatments can be effective for pediatric migraine," senior study author Cosima Locher of the division of clinical psychology and psychotherapy at the University of Basel, in Switzerland, said by email. Short term, biofeedback was the second most effective option after self-administered treatments (SMD 1.41), followed by relaxation (SMD 1.38), and psychological treatments (SMD 1.36). The psychological placebo also appeared more effective than the waiting list. Long-term efficacy was greatest for self-administered treatments (SMD 1.40), relaxation (SMD 1.35), psychological treatments (SMD 1.33), and biofeedback (SMD 1.21). The study didn't look at safety. Limitations of the analysis include the small number of studies and participants, researchers note. Some studies in the analysis also included tension headaches and vascular headaches in addition to migraine. Even so, the results suggest that components of the interventions examined in the study could be integrated in a treatment plan that may include pharmacological and behavioral management, said Dr. Andrew Hershey, director of the Headache Center at Cincinnati Children's Hospital Medical Center, in Ohio. "Approaching the treatment of migraine should be multimodal and with increasing availability of new medications, behavioral treatments and even neurophysiological devices, this can be a very broad and individualized approach," Dr. Hershey, who wasn't involved in the study, said by email. —Lisa Rapaport Source
