Effectiveness of cognitive and behavioral strategies in tension-type headache in adults: an overview of systematic reviews

Guido Rolle, Andrea Crocetti

Tension-type headache is a prevalent condition known to produce a substantial impact on patient, with direct and indirect financial costs. It represents a concrete public health priority. Being a multi-factorial disorder, tension-type headache management benefits from a multidisciplinary and integrative approach, which also includes cognitive behavioral therapy.
We conducted a systematic review, which aim was to better understand cognitive and behavioral strategies contribution for tension-type headache in adults and which strategies/interventions are most recommended.
We found 26 systematic reviews that met our inclusion criteria. We also found an overview of systematic reviews with meta-analysis, exploring the efficacy of psychological treatments for headaches and interesting guidelines about the treatment of tension-type headache. A large number of cognitive-behavioral strategies have been used to treat episodic or chronic tension-type headache. The European Federation of Neurological Societies offers levels of recommendation for cognitive-behavioral treatments: level A for EMG biofeedback; level C for cognitive behavioral therapy and relaxation training.
There is substantial evidence in favor of cognitive-behavioral intervention for tension-type headache management in adults, but additional studies are still necessary to understand specific protocols.

Keywords
Tension-type headache, Chronic headache, Cognitive-behavioral therapy, Cognitive Strategies/intervention, Behavioral strategies/intervention

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