***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: SYNOPSIS A self-help approach for the control of  migraine headaches was evaluated . Self-help refers to a self-directed effort , without therapist contact aim ed at reducing the symptoms of migraine . The experimental plan involved giving migraine headache patients one of two experimental books and then evaluating the effect . Subjects were recruited through newspaper announcements and were required to have had at least two vascular headaches per month . During the first six weeks of the study , the baseline period , all subjects recorded headache frequency , intensity and duration . Subjects were then matched for headache frequency and then r and omly assigned to receive either the treatment or control book . The treatment book contained instructions for thermal biofeedback , relaxation and cognitive behavior therapy . A liquid crystal device for measuring fingertip temperature was also included . Instructions in the treatment book were written such that a self-help , no-therapist treatment could be followed by the subject . The control book was a popularly available paperback in which a series of case studies on headache treatment and diagnosis were discussed . It was selected because it was easy to read and contained information about headaches but did not necessarily direct the reader to start a self-help program . Data was obtained for 51 subjects who completed a three- and six-month followup data collection period ( treatment N = 22 , control N = 29 ) . There was a 62 % decrease in headache frequency at six months for subjects who received the treatment book and a 14 % drop for those who received the control book . Corresponding findings were also obtained for duration and pain levels of the headache as well as for prescribed medication use . Although the results indicated that this type of self-help treatment could be effective for many migraine patients , limitations and caution s in interpretation of these results were discussed OBJECTIVE The objective of this study was to evaluate the effectiveness of a Self-Administered Behavioral Intervention using Tailored messages ( SEABIT ) for migraine . The primary measures were headache days , headache-related disability , behavioral/emotional factors , and headache-related beliefs . BACKGROUND Behavioral and cognitive-behavioral interventions for migraine treatment are well established and possess " Grade -A " evidence based on the U.S. Headache Consortium evidence -based guidelines . To increase the accessibility of behavioral interventions in primary and other setting s , treatment can be delivered in self-administered formats . Incorporating tailored health communication strategies ( via tailored messages ) into a self-administered format can help maintain a level of personalization without requiring regular visits to a behavioral specialist . Tailored messages are created using individual-level assessment data to educate and motivate the patient to develop behavioral skills and strategies for migraine prevention and management . METHODS Twenty-five individuals ( 95 % female , 90 % Caucasian , mean headache years = 21.0 ) began and 84 % ( 21/25 ) completed all phases of the 8-week SEABIT developed for  migraine prevention  ( preceded by a 1-month baseline phase and followed by a 1-month postintervention phase ) . RESULTS Overall , 62 % ( 13/21 ) reported at least a 50 % reduction in headache frequency , and mean headache frequency for the group was also significantly reduced from baseline to postintervention ( 16.9 vs. 10.7 , P < .001 ; eta2= .61 ) . Headache-related disability , behavioral/emotional factors , and headache-management self-efficacy also showed significant improvement . CONCLUSION The findings suggest that the SEABIT for migraine prevention is an effective behavioral intervention that potentially could be accessed and distributed in a variety of setting s including primary care Abstract Forty-one headache patients were classified into tension-headache , migraine or combinedheadache groups . After a 2 1 2 -week baseline period they were assigned to either autogenic training ( AT ) or progressive relaxation ( PR ) . Treatment was conducted in small groups over 12 sessions . Three months after treatment , the patients returned for a follow-up session . Patients charted their headache every 4 hr throughout the baseline and treatment periods and again 2 weeks prior to the follow-up session . PR was more successful in the treatment of tension headache , whereas for migraine cases , both treatments seemed equally effective . For combined headaches , PR lagged behind AT . Among headache Subparameters , the duration and frequency of pain periods were mainly affected , with the exception of the tension-headache PR condition , in which decreases in duration and intensity of pain occurred jointly OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review Forty-eight adolescents suffering from recurrent tension headache participated in a controlled trial conducted in a high school setting . During the first treatment phase self-help relaxation training was compared with a waiting-list group . Following this phase a pharmacological regimen consisting of a muscle relaxant ( chlormezanone ) and placebo was superimposed on relaxation therapy in a double-blind crossover design . Each treatment phase encompassed a 5-week period . In addition to the evaluation of headache complaints , psychological distress among students  was measured with respect to their experience of somatic complaints , depressive , anxiety and stress symptoms . Although self-help relaxation training significantly decreased the severity and annoyance of adolescents ' headache besides their somatic complaints , the clinical improvement of headache was modest . The addition of chlormezanone did not help those who were nonresponders to self-help relaxation training . Finally , a set of pretreatment variables consisting of baseline headache severity and annoyance , experience of anxiety and daily life stress among adolescents could predict outcome of self-help relaxation therapy A comparison was carried out of the efficacy of psychological and drug treatments for children with migraine . Forty-three children aged between 8 and 16 years ( mean age : 11.3 years ) who suffered from migraine received either progressive relaxation or cephalic vasomotor feedback , both with stress management training , or metoprolol , a beta-blocker . Psychological treatment was administered in ten sessions lasting six weeks and the drug treatment lasted ten weeks . Relaxation and stress management training reduced the headache index ( frequency x intensity of headache episodes ) , more effectively than metoprolol with cephalic vasomotor feedback and stress management training in between . An overall improvement over time was found with regard to frequency and intensity of headache episodes and analgesics intake . When comparing pre- to post-treatment data , children treated with relaxation training improved significantly in headache frequency and intensity , whereas those treated with cephalic vasomotor feedback improved significantly in headache frequency and duration as well as mood . The clinical improvement was stable at an 8-months follow-up To assess the efficacy of electromyographic biofeedback , relaxation-response training and pain behavior management as a treatment for  pediatric migraine  , we studied 18 children between the ages of eight and 12 years ( mean = 10 X 1 ) in a prospect i ve , r and omized , controlled investigation . Six patients received all three treatment procedures , six received relaxation-response training and pain behavior management , and the remaining six constituted a waiting-list control group . All patients kept a record of their headaches for the 15-week study period and then for four weeks one year later . Following four weeks of baseline , the treatment groups completed nine one-hour treatment sessions in 11 weeks . Both treatment groups experienced a significant reduction in headache symptoms and were significantly improved compared to the waiting-list control group by the end of treatment . The treatment groups did not differ from each other in any of these comparisons . The reduction in headache symptoms in the treatment groups was maintained one year after treatment ended . These results suggest that relaxation-response training , with or without biofeedback training , combined with pain behavior management , is an effective alternative treatment for pediatric migraine The relative efficacy of EMG-frontalis feedback and progressive relaxation was examined in children with tension-type or combined headaches ( 8–14 yrs . old ) . Furthermore , the influence of parent involvement , in the form of a three-session educational approach , on training outcome was systematic ally explored ( 2 × 2 factor design ) . Fifty children took part in the study , 40 were r and omly assigned to the four different treatment conditions , 10 children participated in the self-monitoring control group .  The training comprised 6 sessions of 1 hr each in the relaxation treatment and 12 sessions of 1/2 hr duration in the biofeedback group . Headache diaries were kept by children and parents for 4-week period prior to therapy , and for a similar length of time at post-treatment and follow-up ( 6 months ) . Multivariate analyses of variance on the headache diary data yield no significant main or interaction effects of treatment format or of parent involvement , but only a main effect of period , indicating a general efficacy of the four treatment conditions . At follow-up the reduction of headache activity is even more prominent . A different evaluative approach points to the superiority of biofeedback revealing a mean effect size for biofeedback training that reflects a good to excellent improvement rate . Correlations between headache data from children and parents are high SYNOPSIS Abstract Introduction . Multimodal approaches in behavioral treatment have gained recent interest , with proven efficacy for migraine . The utility of the Internet has been demonstrated for behavioral treatment of headache disorders , but not specifically for migraine . The aim of the study was to develop and evaluate an Internet-based multimodal behavior treatment ( MBT ) program for migraine and to test h and massage treatment as an adjunct . Methods . Eighty-three adults , 58 women and 25 men , with at least two migraine attacks a month were recruited via advertisements . An MBT program aim ing at improvements in life-style and stress coping was developed for this study and , together with a diary , adapted for use over the Internet . Participants were r and omized to MBT with and without h and massage and to a control group , and were followed for 11 months . Question naires addressing issues of quality of life ( PQ23 ) and depressive symptoms ( MADRS-S ) were used . Results . A 50 % , or greater , reduction in migraine frequency was found in 40 % and 42 % of participants of the two groups receiving MBT ( with and without h and massage , respectively ) , who statistically were significantly more improved than participants in the control group . No effect of  h and massage  was detected , and gender did not show any independent contribution to the effect in a multivariate analysis . Conclusions . MBT administered over the Internet appears feasible and effective in the treatment of migraine , but no effect of h and massage was found . For increased knowledge on long-term effects and the modes of action of the present MBT program , further studies are needed & NA ; A comparative study of the use of GSR feedback  ( n = 16 ) and Schultz relaxation  ( n = 15 ) with patients presenting tension headaches showed that there was no significant improvement in the group treated by relaxation at the end of the treatment whereas the group treated by GSR feedback showed significant improvements with respect to frequency and intensity of headaches and to anxiety as measured by subjects ' self‐evaluation ( P < 0.05 ) . Intergroup comparison demonstrated a greater improvement in headache intensity for the GSR feedback group than for the relaxation group ( P < 0.05 ) at the post‐treatment stage . Likewise , the percentage of patients showing at least 50 % improvement as to headache frequency was significantly higher ( P < 0.05 ) in the GSR feedback than in the relaxation group . High pre‐treatment EMG and high pre‐treatment weekly pain level indicate a good prognosis of improvement with respect to post‐treatment headache frequency and intensity respectively in the case of the GSR feedback group . We found no prognostic factor for post‐treatment clinical improvement in the relaxation group OBJECTIVE AND DESIGN Using a r and omized design with a waiting list control condition , we assessed the effectiveness of an abbreviated cognitive therapy group program for  headaches in children 7 to 12 years of age . In the treatment condition , small groups of five to eight children were taught relaxation , distraction , visualization , and stress management skills in two 90-minute sessions . Parent groups , seen concurrently , review ed the children 's program and addressed parenting strategies . The waiting list control groups were treated 5 weeks later . Thirty-six children meeting inclusion criteria were included in the study ; complete data were available for 29 participants ( mean age , 9.4 years ; 66 
    Output:
    
The broad scope of research on efficacy of psychological treatments for HA is reflected by variation in clinical and method ological characteristics of the review s. These variations were explored through meta- analysis and subgroup analysis of 41 primary studies and showed that some of these variations , including time of assessment , treatment type , age , HA diagnosis , and study quality , can impact the magnitude of treatment effect .
DISCUSSION There is substantial evidence in favor of psychological treatments for HA management .