***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: Background and Purpose Behavioral medicine interventions that directly reduce arousal and negative emotions , such as relaxation training ( RT ) , are conceptually different from interventions that temporarily increase negative emotions , such as written emotional disclosure ( WED ) , but no studies have directly compared their efficacy . We compared the effects of RT and WED on people with tension or migraine headaches . Methods College students with either tension ( n = 51 ) or migraine ( n = 90 ) headaches were r and omized to one of three groups : RT , WED , or a neutral writing control condition ; four sessions were held over 2 weeks . Mood was measured before and after each session , and outcomes ( headache frequency , severity , disability , and general physical symptoms ) were assessed at baseline and at 1-month and 3-month follow-ups . Results As expected , RT led to an immediate increase in calmness , whereas WED led to an immediate increase in negative mood , for both headache sample s. Intent-to-treat analyses showed that , for the tension headache sample , RT led to improved headache frequency and disability compared to both WED and the control group , but WED had no effect . For migraine headaches , RT improved pain severity relative to the control group , but WED again had no effect . Conclusions A brief RT protocol was effective for tension headaches , but WED had no effect on health status for either tension or migraine headaches . Modifications to WED , such as targeting people with unresolved stress , providing guidance to enhance the potency of the writing , or including additional at-home writing and exposure exercises , may improve its efficacy for people with headaches and other health problems Background Modification of expectancies ( headache self-efficacy and headache locus of control ) is thought to be central to the success of psychological treatments for migraine . Purpose The purpose of this study is to examine expectancy changes with various combinations of Behavioral Migraine Management and migraine drug therapies . Methods Frequent migraine sufferers who failed to respond to 5 weeks of optimized acute migraine drug therapy were r and omized to a 2 ( Behavioral Migraine Management+ , Behavioral Migraine Management− ) × 2 ( β-blocker , placebo ) treatment design . Results Mixed models for repeated measures analyses ( N = 176 ) revealed large increases in headache self-efficacy and internal headache locus of control and large decreases in chance headache locus of control  with Behavioral Migraine Management+ that were maintained over a 12-month evaluation period . Chance headache locus of control and socioeconomic status moderated changes in headache self-efficacy  with Behavioral Migraine Management+ . Conclusions The “ deficiency ” hypothesis best explained how patient characteristics influenced changes in of headache self-efficacy with Behavioral Migraine Management Aim : Scientific evidence regarding exercise in migraine prophylaxis is required . Therefore this study aim ed to evaluate the effects of exercise in migraine prevention . Methods : In a r and omized , controlled trial of adults with migraine , exercising for 40 minutes three times a week was compared to relaxation according to a recorded programme or daily topiramate use , which was slowly increased to the individual ’s highest tolerable dose ( maximum 200 mg/day ) . The treatment period lasted for 3 months , and migraine status , quality of life , level of physical activity , and oxygen uptake were evaluated . The primary efficacy variable was the mean reduction of the frequency of migraine attacks during the final month of treatment compared with the baseline . Results : Ninety-one patients were r and omized and included in the intention-to-treat analysis . The primary efficacy variable showed a mean reduction of 0.93 ( 95 % confidence interval ( CI ) 0.31–1.54 ) attacks in the exercise group , 0.83 ( 95 % CI 0.22–1.45 ) attacks in the relaxation group , and 0.97 ( 95 % CI 0.36–1.58 ) attacks in the topiramate group . No significant difference was observed between the groups ( p = 0.95 ) . Conclusion : Exercise may be an option for the prophylactic treatment of migraine in patients who do not benefit from or do not want to take daily medication BACKGROUND Sleep problems have been linked with headaches for more than a century , but whether the headaches are the cause or the result of the disrupted sleep is unknown . OBJECTIVES We previously reported that nonrestorative sleep and poor sleep habits are almost universal in a referral population of women with transformed migraine ( TM ) . Since cognitive behavioral therapy is effective in improving sleep quality in individuals with poor sleep hygiene , we design ed a r and omized , placebo-controlled study to assess the impact of such treatment on TM . We hypothesized that behavioral sleep modification ( BSM ) would be associated with improvement in headache frequency and intensity and with reversion to episodic migraine . METHODS Subjects were 43 women with TM referred to an academic headache center . After obtaining informed consent , patients were r and omized to receive either behavioral sleep instructions or placebo behavioral instructions in addition to usual medical care . Subjects recorded headaches in st and ardized diaries . The first postintervention visit was scheduled at 6 weeks . At that visit , the blind was broken and all subjects received BSM instructions . A final visit was scheduled 6 weeks later . RESULTS Compared to the placebo behavioral group , the BSM group reported statistically significant reduction in headache frequency [ F ( 1 , 33 = 12.42 , P=.001 ) ] and headache intensity [ F(1 , 33 = 14.39 , P= .01 ) ] . They were more likely to revert to episodic migraine chi2 ( 2 , n = 43 ) = 7.06 , P= .029 . No member of the control group reverted to episodic migraine by the first postintervention visit . By the final visit , 48.5 % of those who had received BSM instructions had reverted to episodic migraine . CONCLUSIONS In this pilot study of women with TM , we found that a targeted behavioral sleep invention was associated with improvement in headache frequency , headache index , and with reversion to episodic migraine Headache is being viewed more commonly in a biopsychosocial framework , which introduces the possible utilisation of psychological treatment options , such as cognitive behavioural therapy and relaxation . No such treatments have been trialled in the UK . We conducted a r and omised controlled pilot trial , comparing a brief guided self-help CBT and relaxation treatment with st and ard medical care ( SMC ) , in a UK NHS setting . Participants were recruited from specialist headache clinics across London . Participants were r and omised to receive either treatment or st and ard medical care .  Our objective was to provide design information necessary for a future definitive trial of the SHE treatment , including , recruitment/retention rates , acceptability of r and omisation , treatment fidelity and estimations of mean and variances of outcome measures .  From the initial 275 patients identified , 73 were r and omised . There was no difference in drop-out rates between SMC and treatment groups . Of the 36 participants r and omised to receive treatment , 72 % attended all sessions . Findings show that a future definitive trial of the SHE treatment is feasible , with small modifications of protocol , within a UK NHS context Biofeedback with or without combined autogenic training is known to be effective for the treatment of migraine . This study aim ed to examine the effect of biofeedback treatment on headache activity , anxiety , and depression in Korean female patients with migraine headache . Patients were r and omized into the treatment group ( n=17 ) and monitoring group ( n=15 ) . Mood states including anxiety and depression , and psychophysiological variables such as mean skin temperature of the patients were compared with those of the normal controls ( n=21 ) . We found greater treatment response rate ( defined as ≥50 % reduction in headache index ) in patients with biofeedback-assisted autogenic training than in monitoring group . The scores on the anxiety and depression scales in the patients receiving biofeedback-assisted autogenic training decreased after the biofeedback treatment . Moreover , the decrease in their anxiety levels was significantly related to the treatment outcome . This result suggests that the biofeedback-assisted autogenic training is effective for the treatment of migraine and its therapeutic effect is closely related to the improvement of the anxiety level 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 OBJECTIVES To evaluate utility of biofeedback assisted diaphragmatic breathing and systematic relaxation in migraine and to compare their efficacy with propranolol in long term prophylaxis of migraine . METHODS 192 migraine patients were r and omly distributed into two groups . Propranolol group received propranolol 80 mg/day while biofeedback group received electromyogram ( EMG ) and temperature biofeedback assisted diaphragmatic breathing and systematic relaxation training accompanied by home practice for 6 months . RESULTS Significant clinical response was seen with biofeedback in 66.66 % and with propranolol in 64.58 % of patients . Frequency , severity , duration of attacks and number of vomiting episodes were significantly reduced in both the groups at 6 months but inter-group differences were statistically insignificant . During 1 year post-treatment period , significantly lesser resurgence of migraine was seen in biofeedback group as whole ( 9.37 % ) and in biofeedback responders in biofeedback group ( 9.37 % ) in comparison to resurgence of migraine in propranolol group as whole ( 38.54 % ) and in propranolol responders in propranolol group ( 53.22 % ) respectively . CONCLUSIONS Biofeedback assisted diaphragmatic breathing and systematic relaxation were very useful in migraine and had significantly better long-term prophylactic effect than propranolol in migraine & NA ; This paper reports the development of a scale for assessing the quality of reports of r and omised controlled trials for psychological treatments .  The Delphi method was used in which a panel of 15–12 experts generated statements relating to treatment and design components of trials . After three rounds , statements with high consensus agreement were review ed by a second expert panel and rewritten as a scale . Evidence to support the reliability and validity of the scale is reported . Three expert and five novice raters assessed sets of 31 and 25 published trials to establish scale reliability ( ICC ranges from 0.91 to 0.41 for experts and novices , respectively ) and item reliability ( Kappa and inter‐rater agreement ) . The total scale score discriminated between trials globally judged as good and poor by experts , and trial quality was shown to be a function of year of publication . Uses for the scale are suggested Objective : The objective of this pilot study was to address the influence of an aerobic exercise program combined with relaxation on pain and psychological variables in migraine patients . Design : Controlled , r and omised design with half of the group receiving an intervention ( aerobic exercise group ) in addition to st and ard medical care received by all patients . Setting / Patients / Outcome Measurement : Thirty female migraine out patients completed a range of psychological question naires measuring sensational and affective dimensions of pain , body image , depression , and quality of life . Intervention : The aerobic exercise group ( n = 15 ) participated in a 6-week , twice-weekly , indoor exercise program ( 45 minutes of gymnastics with music and 15 minutes of progressive muscle relaxation ) . Results / Conclusion : The program led to a significant reduction of self-rated migraine pain intensity . Although there was an improvement in depression-related symptoms within the aerobic exercise group , no significant differences in psychological variables between groups were found Objectives : To characterize overall drug use in migraine in conjunction with multimodal behavioral treatment ( MBT ) . Methods : Seventy-six adults reporting at least two monthly migraine attacks underwent a r and omized , controlled , 24-week MBT intervention .  Migraine drugs and symptoms were registered in an Internet-based diary . Results : During 4256 days of baseline registration , 859 drug doses were taken during 655 of the 856 days with migraine headache . Triptans and analgesics constituted 56.7 and 38.3 % of all doses with efficacy ratios of 0.41 and 0.20 , respectively . Men displayed significantly lower drug efficacy ( p = 0.001 ) , and used  triptans  significantly less ( p < 0.001 ) and analgesics significantly more ( p < 0.001 ) than women . At the end of the MB 
    Output:
    
We conclude that evidence supports the efficacy of psychological interventions in migraine .