Migraine Sessions at CONy 2019

This year’s CONy featured intriguing debates on alternative modes of treatment for migraine—an extremely debilitating disorder affecting 1 in 10 individuals globally.1 With several new prophylactic treatments currently available, opportunities are emerging for easing the burden of suffering in patients with migraine.

In a session hosted by Dr. Robert E. Shapiro (University of Vermont, VT, USA), migraine experts Drs. Steven M. Baskin (New England Institute for Neurology and Headache, Stamford, CT, USA) and Mark Braschinsky (Tartu University Hospital, Headache Clinic, Estonia) debated whether cognitive behavioral therapy (CBT) and biofeedback training can be as effective as medication in the prophylactic treatment of migraine.

Representing the view that preventive pharmacotherapy can be replaced by psychological interventions in certain patients, Dr. Baskin argued that psychological intervention can train the individual to manage stress and other headache triggers, as well as promoting wellness activities and healthy sleeping habits. Dr. Baskin cited the expert opinions of well-renowned migraine specialists Drs. Dimos Mitsikostas and Alan Rapoport that the current standard preventive treatments for migraine were fraught with challenges, such as lack of efficacy in a large number of patients, tolerability and safety issues, and non-compliance.2 In this context, and backed by recent clinical evidence, Dr. Baskin posited that CBT and biofeedback training constitute a set of safer, more cost-effective, and complementary approaches that could have a significant impact on patients’ quality of life.

Taking the opposing view, Dr. Braschinsky reviewed recent clinical data that did not show clear evidence of clinical efficacy of non-pharmacologic interventions. According to Dr. Braschinsky, clinical trials to date suffer from fundamental methodological flaws, which render their findings unreliable. Such limitations include poorly defined inclusion criteria, small number of patients, and unclear intervention. Therefore, Dr. Braschinsky concluded that CBT and biofeedback training do not currently have convincing data on disability, number of headache days, and number of headache attacks.

At the end of the debate, while the audience was evenly split between the 2 opposing positions, Drs. Braschinsky and Baskin both agreed that standardized protocols are needed in order to obtain more robust data in this area.

References

  1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis of the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-602.
  2. Mitsikostas DD, et al. New players in the preventive treatment of migraine. BMC Med. 2015;13:279. doi: 10.1186/s12916-015-0522-1.