title: Electronic behavioral interventions for headache: a systematic review.
abstract: BACKGROUND
  There is increasing interest in using electronic behavioral interventions as well as mobile technologies such as smartphones for improving the care of chronic disabling diseases such as migraines. However, less is known about the current clinical evidence for the feasibility and effectiveness of such behavioral interventions.
  
  
  OBJECTIVE
  To review the published literature of behavioral interventions for primary headache disorders delivered by electronic means suitable for use outside of the clinician's office.
  
  
  METHODS
  An electronic database search of PubMed, PsycINFO, and Embase was conducted through December 11, 2015. All eligible studies were systematically reviewed to examine the modality in which treatment was delivered (computer, smartphone, watch and other), types of behavioral intervention delivered (cognitive behavioral therapy [CBT], biofeedback, relaxation, other), the headache type being treated, duration of treatment, adherence, and outcomes obtained by the trials to examine the overall feasibility of electronic behavioral interventions for headache.
  
  
  RESULTS
  Our search produced 291 results from which 23 eligible articles were identified. Fourteen studies used the internet via the computer, 2 used Personal Digital Assistants, 2 used CD ROM and 5 used other types of devices. None used smartphones or wearable devices. Four were pilot studies (N ≤ 10) which assessed feasibility. For the behavioral intervention, CBT was used in 11 (48 %) of the studies, relaxation was used in 8 (35 %) of the studies, and biofeedback was used in 5 (22 %) of the studies. The majority of studies (14/23, 61 %) used more than one type of behavioral modality. The duration of therapy ranged from 4-8 weeks for CBT with a mean of 5.9 weeks. The duration of other behavioral interventions ranged from 4 days to 60 months. Outcomes measured varied widely across the individual studies.
  
  
  CONCLUSIONS
  Despite the move toward individualized medicine and mHealth, the current literature shows that most studies using electronic behavioral intervention for the treatment of headache did not use mobile devices. The studies examining mobile devices showed that the behavioral interventions that employed them were acceptable to patients. Data are limited on the dose required, long term efficacy, and issues related to the security and privacy of this health data. This study was registered at the PROSPERO International Prospective Register of Systematic Reviews (CRD42015032284) (Prospero, 2015).
authors.affiliation: Department of Neurology, NYU Langone Medical Center, 240 East 38th Street 20th floor, New York, NY, 10016, USA. minenmd@gmail.com.|NYU Langone Headache Center, Department of Neurology, NYU School of Medicine, New York, NY, USA. minenmd@gmail.com.
authors.forename: Mia Tova
authors.initials: MT
authors.lastname: Minen
authors.affiliation: Department of Psychiatry, Beth Israel Deaconess Medical Center and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Torous
authors.affiliation: NYU School of Medicine, New York, USA.
authors.forename: Jenelle
authors.initials: J
authors.lastname: Raynowska
authors.affiliation: Department of Library Services, NYU School of Medicine, New York, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Piazza
authors.affiliation: Department of Emergency Medicine, NYU Langone Medical Center, NYU School of Medicine, New York, NY, USA.
authors.forename: Corita
authors.initials: C
authors.lastname: Grudzen
authors.affiliation: Cincinnati Children's Medical Center, Headache Center, Office for Clinical and Translational Research, Center for Child Behavior and Nutrition Research and Training, Pediatrics Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Powers
authors.affiliation: Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, Neurology, Bronx, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Lipton
authors.affiliation: Center for Behavioral Change, Department of Population Health, NYU School of Medicine, New York, NY, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Sevick
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000295:instrumentation* / Q000379:methods; D034201:Computers, Handheld / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006261:Headache / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D020407:Internet; D008297:Male; D011446:Prospective Studies
keywords: Behavioral medicine; Biofeedback; Cognitive behavioral therapy; Electronic; Headache; Migraine; Progressive muscle relaxation therapy