AN EMERGING treatment model for migraine integrates behavioral and pharmacologic approaches via telehealth, potentially improving access and outcomes for patients with this highly disabling neurological condition. The new perspective, published in Headache, advocates for personalized, combination strategies that address both the physiological and psychological components of migraine.
Migraine management traditionally relies on either medication or behavioral interventions, but rarely both in tandem. This binary approach may fall short for many patients, especially given the growing understanding of migraine as a multifaceted disease involving not only head pain and sensory sensitivity, but also cognitive and emotional symptoms. Non-pharmacologic treatments such as acceptance and commitment therapy (ACT) remain underutilized, largely due to systemic barriers in access, delivery, and reimbursement.
The article proposes a framework that combines CGRP-targeting pharmacological therapies with behavioral strategies like ACT, using telehealth platforms to deliver care more equitably. Drawing on evidence from the American Headache Society and several randomized trials, the author outlines how these interventions can reinforce one another: medication addressing neurobiological pathways while behavioral therapy strengthens patient coping and adherence.
Notably, a pediatric trial combining cognitive behavioral therapy (CBT) and amitriptyline showed significant benefit, while adult studies incorporating both behavioral and pharmacologic components reported improved migraine control. However, few high-quality trials have rigorously evaluated dual-treatment models. A recent systematic review found low overall evidence strength, attributed in part to the mismatch between trial designs suited for drugs versus those needed for behavioral therapies.
The article calls for future clinical trials to specifically assess integrated treatment models in the migraine space, leveraging telehealth platforms to overcome logistical and geographic barriers. Such trials would offer more definitive insights into how behavioral and drug therapies may synergistically reduce attack frequency, severity, and patient burden.
As telehealth continues to evolve post-pandemic, this combined approach may mark a critical step toward more comprehensive, personalized migraine care.
Reference:
Monteith TS et al. Combination behavioral and pharmacological interventions through telehealth platforms: Opportunities for increasing access and optimizing migraine outcomes. Headache. 2025;00:1-3.
