Behavioral therapies in headache: focus on mindfulness and cognitive behavioral therapy in children and adolescents

ABSTRACT

Introduction: A wide proportion of children and adolescents with headache tends not to respond to various pharmacological treatments in use. The failure to respond to symptomatic treatment and prophylaxis is often due to the presence of a comorbid psychopathology undiagnosed or not properly treated. For these reasons and for the negative impact of headache on the quality of life of the patients and on the costs for the public health system, the adoption of an integrated multi-disciplinary perspective in the diagnosis and treatment of headache is needed.

Areas covered: Several researchers have shown that behavioral treatment is effective as pharmacological treatment, not only for headache management but also to maintain a lifetime response to the headache treatment. In particular, Cognitive Behavioral Therapy (CBT) and Mindfulness have proven to be very resolutive both in the management of pain and in the management of stressful situations that can trigger the headache in children and adolescents with headache.

Expert opinion: Although studies on behavioral treatments on children and adolescents with primary headaches are still few but a combined approach seems to be very useful in improving the quality of life of these subjects, especially in those who have internalizing disorders in comorbidities.

KEYWORDS:

• Behavioral treatment
• mindfulness
• cognitive behavioral therapy
• headache
• children
• adolescents

Article highlights

• The adoption of an integrated multi-disciplinary perspective in the diagnosis and treatment of headache is needed.

• Behavioral treatment is as effective as pharmacological treatment, not only for headache management but also to maintain a lifetime response to the headache treatment.

• The effectiveness of CBT in the treatment of headache is likely due in part to the management of both pain-related behavior and neurophysiological changes to the brain.

• Mindfulness represents a promising adjunct treatment for children and adolescents with recurrent headaches, since it improves the quality of life, the acceptance of pain and the physical functioning.

• A warning point to highlight is that CBT and MBIs must not be exclusive, but they must be accompanied by standardized treatment for headaches.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.