Centre for Headache, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
Wasser Pain Medicine Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Headache. 2023 Sep;63(8):1031-1039. doi: 10.1111/head.14624. Epub 2023 Aug 28.
In this narrative review, we summarize relevant literature pertaining to psychosocial risk factors for headache and migraine progression, current behavioral and psychological treatments, and consider promising treatments.
Headache and migraine are common and associated with significant burden and disability. Current treatments targeting psychosocial risk factors show modest outcomes and do not directly address the impact of early life adversity, including the development of maladaptive emotional processing. An intervention that could address these factors and include components of current evidence-based interventions may lead to improved outcomes.
We searched PubMed and Google Scholar for articles through December 2022. Search terms included headache, migraine, psychological interventions, behavioral interventions, cognitive-behavioral therapy, mindfulness, psychiatric comorbidities, adverse childhood experiences, trauma, and emotional processing.
Trauma and childhood adversity show a correlation with headache and migraine progression. Developmental adversity and trauma interfere with adaptive emotional processing, which may worsen headache and migraine symptoms, while adaptive ways of experiencing emotions are shown to improve symptoms. Current behavioral and psychological interventions, such as cognitive-behavioral and mindfulness therapies, are effective treatments for headache, but they produce small to medium effect sizes and do not directly address the impact of trauma and emotional conflicts-common factors that contribute to chronicity and disability, especially among certain subpopulations of headache patients such as those with migraine. Thus, there exists a gap in current treatment.
There is a gap in headache and migraine treatment for those patients who have a history of trauma, childhood adversity, and maladaptive emotional processing. We suggest that an integrated psychological treatment that includes components of current evidence-based interventions and addresses gaps by focusing on processing trauma-related emotions may improve chronic and debilitating symptoms.
在这篇叙述性综述中，我们总结了与头痛和偏头痛进展相关的心理社会风险因素的相关文献，目前的行为和心理治疗，并考虑了有前途的治疗方法。
头痛和偏头痛很常见，会给患者带来很大的负担和残疾。目前针对心理社会风险因素的治疗方法显示出适度的效果，并且不能直接解决早期生活逆境的影响，包括适应性情绪处理的发展。一种可以解决这些因素并包含当前循证干预措施组成部分的干预措施可能会带来更好的结果。
我们通过 2022 年 12 月在 PubMed 和 Google Scholar 上搜索了相关文章。搜索词包括头痛、偏头痛、心理干预、行为干预、认知行为疗法、正念、精神共病、不良童年经历、创伤和情绪处理。
创伤和童年逆境与头痛和偏头痛的进展有关。发育逆境和创伤会干扰适应性情绪处理，这可能会使头痛和偏头痛症状恶化，而适应性的情绪体验方式则被证明可以改善症状。目前的行为和心理干预措施，如认知行为疗法和正念疗法，是治疗头痛的有效方法，但它们的效果较小，并且不能直接解决创伤和情绪冲突的影响，这些因素是导致慢性和残疾的常见因素，尤其是在偏头痛等头痛患者的某些亚人群中。因此，目前的治疗存在差距。
对于有创伤、童年逆境和适应性情绪处理不良史的头痛和偏头痛患者，治疗存在差距。我们建议，一种综合的心理治疗方法，包括当前循证干预措施的组成部分，并通过关注处理与创伤相关的情绪来解决差距，可能会改善慢性和使人衰弱的症状。
