Autogenic training for tension type headaches: A systematic review of controlled trials

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Summary

Objective

To determine from the published evidence whether autogenic training as sole therapy is effective for prevention of tension-type headaches in adults.

Method

Systematic review of controlled trials. Literature searches were performed in January 2005 in six major databases, specifically Medline, EMBASE, AMED, CENTRAL, PsychInfo and CINAHL and information was extracted and evaluated in a pre-defined manner.

Results

Seven controlled clinical trials were included in the review. The methodological quality of these studies was low. Patient samples were generally representative of the more severely affected cases. None of the studies show autogenic training to be convincingly superior to other interventions care. Some trials suggested that the effect of autogenic training is no different from hypnosis and inferior to biofeedback.

Conclusion

There is no consistent evidence to suggest that autogenic training is superior to other interventions for prevention of tension headaches, or different from other forms of relaxation. Further studies should investigate the use of standard autogenic training in patients with moderate headache.

Introduction

Headache is one of the most common conditions experienced in western society, though there is considerable variation in prevalence and severity in different settings. Episodic tension-type headache (TTH) on several days per month is reported by an average of 37% of the population.1 The social and economic consequences of headache are considerable2, due to loss of work days and days with reduced work efficiency.3, 4 Pharmacological treatment is often disappointing and patients frequently use various forms of complementary therapies including physical methods such as massage, reflexology and spinal manipulation2, 5 and behavioural techniques. An effective self-help therapy that is non-pharmacological and is cheap and simple to use would be of considerable interest to patients and health providers.

Autogenic training (AT) is a self-help relaxation technique that was invented by a German psychiatrist named Johannes Schultz6 and further developed by Luthe.7 The AT technique consists of six standard exercises. The first exercise aims at muscular relaxation, which is achieved mainly by repeating a verbal formula to encourage heaviness. Subsequently, the concentration is focussed passively on feeling warm, then calming the cardiac activity, slowed respiration, warmth in the abdominal region and finally coolness in the head. The technique is usually learnt in groups over a period of 8 weeks and home practice of the exercises at least three times daily is encouraged.8

Relaxation techniques including AT are particularly recommended for prophylaxis of conditions which are caused or exacerbated by mental stress, which include tension-type headache.9 A meta-analysis of various forms of biofeedback and relaxation therapy for tension headache found their effect to be superior to no treatment.10 However, that review did not consider AT individually, so we decided to perform a systematic review to investigate the effectiveness of AT for tension-type headache when compared to no additional treatment, to other treatments or to sham interventions.

Section snippets

Data sources and search strategy

The following databases were searched in January 2005: Medline (1969–2005), EMBASE (1974–2005), AMED (Allied & Complementary Medicine, 1985–2005), CENTRAL (2005), PsychInfo (1974–2005) and CINAHL (Cumulative Index of Nursing and Allied Health Literature, 1982–2005) for possible controlled trials. Searches were performed using the keywords “autogenic training” or “autogenic” and “headache”. Reference lists of retrieved reports, published review articles, various textbooks and Luthe's extensive

Results

Twelve reports of controlled trials of AT for headaches were retrieved13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, of which five had to be excluded for the reasons given in Table 3. Essential data of the included studies are presented in Table 4.

Data synthesis

The single study that compares AT with cognitive coping13 is not interpretable because of its small group sizes. The authors state that, by the end of the study ‘all participants had been able to achieve zero levels of headache activity’, but the success cannot be causally attributed to any particular component of the therapy as distinct from ‘relaxation’ in general or expectation effects.

In two studies involving a total of 49 patients, biofeedback with either galvanic skin resistance (GSR)15

Discussion

This systematic review of seven controlled trials has found only limited evidence that AT is superior to waiting list control for TTH; limited evidence that it is less effective than biofeedback; and consistent evidence that the effect of AT on TTH is no different from hypnosis. There are considerable difficulties in drawing conclusions about the effectiveness of ‘standard AT’ from this material because of various limitations.

The evidence overall may be limited by not meeting the quality

Conclusions

The present evidence is insufficient to allow any conclusions to be drawn about the effectiveness of standard AT for TTH. There is consistent evidence that limited forms of AT are similar in effectiveness to hypnotherapy for TTH, and limited evidence that they are less effective than biofeedback. Further research is warranted, using standardised AT and particularly comparing it with biofeedback for acceptability and effectiveness, in primary care patients with moderate symptoms.

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    1

    The author is a nurse and therapist in autogenic training, registered with United Kingdom Council for Psychotherapy.

    2

    Tel.: +44 1752 764448.

    3

    Tel.: +44 1392 430802; fax: +44 1392 424989.

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