Digital headache management interventions, including interactive websites, demonstrated promising effects on headache outcomes in patients with primary headache disorders, according to study findings published in Headache.
Researchers in the United States conducted a systematic review of randomized controlled trials published in either the PubMed, Scopus, or EBSCO databases. They identified 13 eligible studies — most of which were pilot studies — assessing outcomes such as headache frequency, duration, intensity, severity, disability, and quality of life following initiation of a digital headache management intervention.
In 7 studies, researchers analyzed results in adults, while 6 studies consisted of pediatric patients with primary headache disorders. Approximately in 69% (9 of 13) of the studies, researchers exclusively focused on patients with migraine headache. Meanwhile, 2 studies rated low for risk of bias while the researchers had some concerns regarding the other 11.
Patients were predominantly female. Of the 6 studies where researchers reported racial/ethnic composition of trial participants, most consisted of a range between 45 to 94% of White/Caucasian patients.
Digital headache management interventions varied widely, including guided relaxation training, behavioral strategies such as self-monitoring using an electronic headache diary or app tracking and feedback on treatment progress, psychoeducation, biofeedback devices, interactive websites, and cognitive-behavioral therapy (CBT). Intervention durations for each trial ranged from 1 to 6 months with 9 of the 13 studies concluding with post-intervention follow-up assessments.
Combining all interventions and headache outcomes, nearly 70% of the digital interventions resulted in significant improvements in headache outcomes, either between an intervention and control group or within the intervention group comparing pre- and post-intervention status. When comparing the different digital interventions, interactive websites demonstrated the greatest impact on headache outcomes alongside therapist support.
In 8 of the 13 studies, researchers analyzed headache frequency. Headache frequency declined significantly with a 50% or greater reduction in patients participating in 5 of the 13 studies. In the studies that compared digital headache interventions to individuals in a control group, between 29% and 63% of patients in the intervention groups reported decreased headache frequency compared with 13% to 39% in the control groups.
Fewer studies had researchers assess headache duration (4 of 13), headache severity (3 of 13), and headache intensity (5 of 13), with mixed results as far as outcomes. Most studies did not report appreciable differences between or within groups for these outcomes.
In most studies (9 of 13), researchers assessed headache disability with 7 of the 9 studies discovering no significant difference between the treatment and control groups in this outcome.
Meanwhile, in 6 of 13 studies, researchers evaluated quality of life in patients with primary headaches treated with digital headache management interventions. While 4 studies did not demonstrate significant improvements, the other 2 reported improved quality of life, including work performance.
Study limitations included inability to perform a quantitative meta-analysis, heterogeneity of digital interventions and studied outcomes, and the fact that nearly two-thirds of the included studies were pilot studies.
“Efficacy testing of digital headache interventions is in its infancy with the majority of these studies relying on pilot studies with small samples comprised of homogenous patient populations,” the researchers noted. They added, “Interactive websites were the most common digital medium to deliver digital headache management interventions and have demonstrated promising results.”
Further research is warranted among diverse populations to inform health equity of digital headache interventions.
The study was funded by the National Institutes of Health.
Noser AE, Gibler RC, Ramsey RR, Wells RE, Seng EK, Hommel KA. Digital headache self-management interventions for patients with a primary headache disorder: A systematic review of randomized controlled trials. Headache. Published online October 26, 2022. doi:10.1111/head.14392