Are Behavioral Treatments for Headache More Cost-Effective?

Treating chronic migraines with behavioral approaches such as relaxation training, hypnosis, and biofeedback can be more cost effective than prescription-drug treatment, especially after a year or more, a new study found.

"We have a whole armamentarium of behavioral treatments and their efficacy has been proven. But headache sufferers are only getting a tip of these options," said Timothy Houle, PhD, associate professor of anesthesiology and neurology at Wake Forest University, and the study's principal investigator. "One reason is people think behavioral treatment costs a lot. Now with this study, we know that the costs are actually comparable, if not cheaper, in the long run."

The study, which is published in the June issue of the journal Headache, compared the costs over time of several types of behavioral treatments with prescription-drug treatments.

Researchers found that after 6 months, the cost of minimal-contact behavioral treatment—when a patient sees a therapist a few times but largely practices the behavioral techniques at home, aided by literature or audio recordings—was competitive with pharmacologic treatment using drugs costing 50 cents or less a day.

After 1 year, the minimal-contact method was nearly $500 cheaper than pharmacologic treatment.

Although the cost of prescription prophylactic drugs may not seem like much, even at several dollars a day, according to Donald Penzien, PhD, of University of Mississippi Medical Center, a co-author on the study, “those costs keep adding up with additional doctor visits and more prescriptions. The cost of behavioral treatment is front loaded. You go to a number of treatment sessions but then that's it. And the benefits last for years,” he said in a statement.

The researchers didn't compare the effectiveness of methods, nor did they calculate the costs over time of individual drugs, since dosages and prices vary widely. Rather, they figured the per-day costs of each method based on fees of physicians and psychologists. For the physician group, they added in the cost of prescription beta-blocker drugs at various prices.

For instance, among the psychologists surveyed, one-on-one behavioral sessions cost between $70 and $250 for the intake visit and $65 and $200 for follow-up visits. That put the median intake cost at $175 and median follow-up cost at $125 for a median 10 visits.

The researchers calculated the median cost of pharmacologic approaches at $250 for the intake session and a professional fee of $140 per session. Median time to the first follow-up was 52.2 days, rising to 60 for the second with a median five visits per year.

The most expensive behavioral treatment method—individual sessions with a psychologist in clinic— cost more than pharmacologic treatment with $6-a-day drugs in the first months. But at about 5 months, individual sessions become competitive. After a year, they are cheaper than all methods except treatment with drugs costing 50 cents or less a day.

Overall, group therapy and minimal-contact behavioral treatment were cost-competitive with even the cheapest medication treatment in the initial months. At 1 year, they become the least-expensive headache treatment choice.