Harris Petra, Loveman Emma, Clegg Andy, Easton Simon, Berry Neil
Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK.
Department of Psychology, University of Portsmouth, Portsmouth, UK.
Br J Pain. 2015 Nov;9(4):213-24. doi: 10.1177/2049463715578291.
This systematic review aimed to establish if cognitive behavioural therapy (CBT) can reduce the physical symptoms of chronic headache and migraines in adults.
Evidence from searches of eight databases was systematically sought, appraised and synthesised. Screening of title and abstracts was conducted independently by two reviewers. Full papers were screened, data extracted and quality assessed by one reviewer and checked by a second. Data were synthesised narratively by intervention due to the heterogeneity of the studies. The inclusion criteria specified randomised controlled trials with CBT as an intervention in adults suffering from chronic headaches/migraines not associated with an underlying pathology/medication overuse. CBT was judged on the basis of authors describing the intervention as CBT. The diagnosis of the condition had to be clinician verified. Studies had to include a comparator and employ headache/migraine-specific outcomes such as patient-reported headache days.
Out of 1126 screened titles and abstracts and 20 assessed full papers, 10 studies met the inclusion criteria of the review. Some studies combined CBT with another intervention, as well as employing varying numbers of comparators. CBT was statistically significantly more effective in improving some headaches-related outcomes in CBT comparisons with waiting lists (three studies), in combination with relaxation compared with relaxation only (three studies) or antidepressant medication (one study), with no statistically significant differences in three studies.
The findings of this review were mixed, with some studies providing evidence in support of the suggestion that people experiencing headaches or migraines can benefit from CBT, and that CBT can reduce the physical symptoms of headache and migraines. However, methodology inadequacies in the evidence base make it difficult to draw any meaningful conclusions or to make any recommendations.
本系统评价旨在确定认知行为疗法（CBT）是否能减轻成人慢性头痛和偏头痛的身体症状。
系统检索了八个数据库，对证据进行了系统的查找、评估和综合。两名评审员独立进行标题和摘要筛选。由一名评审员筛选全文、提取数据并进行质量评估，另一名评审员进行核对。由于研究的异质性，按干预措施进行了叙述性数据综合。纳入标准规定为随机对照试验，将CBT作为干预措施用于患有慢性头痛/偏头痛且与潜在病理/药物过度使用无关的成年人。根据作者将干预措施描述为CBT来判断是否为CBT。病情诊断必须经临床医生核实。研究必须包括一个对照，并采用头痛/偏头痛特异性结局，如患者报告的头痛天数。
在筛选的1126篇标题和摘要以及评估的20篇全文中，有10项研究符合本评价的纳入标准。一些研究将CBT与另一种干预措施相结合，并且使用了不同数量的对照。与等待名单相比，CBT在改善一些与头痛相关的结局方面具有统计学显著效果（三项研究）；与仅放松相比，CBT联合放松在改善结局方面具有统计学显著效果（三项研究）；与抗抑郁药物相比，CBT联合抗抑郁药物在改善结局方面具有统计学显著效果（一项研究）；三项研究中无统计学显著差异。
本评价的结果喜忧参半，一些研究提供的证据支持了以下观点：患有头痛或偏头痛的人可以从CBT中获益，且CBT可以减轻头痛和偏头痛的身体症状。然而，证据基础中的方法学不足使得难以得出任何有意义的结论或提出任何建议。
