Has the COVID-19 pandemic changed characteristics, administration modalities, and implementation of psychological interventions for chronic headache? An updated systematic review.

Background: The COVID-19 pandemic has brought increased global attention to headache disorders. Building on a pre-pandemic published systematic review covering the period from 2008 to 2018, we updated the literature on evidence-based psychological interventions for adults with chronic headaches (CH), with a specific focus on the potential impact of the pandemic. Besides exploring characteristics of the interventions, evidence, and possible factors influencing their implementation in clinical practice, we aimed to investigate whether the pandemic affected interventions' features, delivery modalities, and uptake. Methods: We conducted a systematic search of PubMed and PsycINFO (2019-2024), checked ClinicalTrials.gov for upcoming trials, and consulted websites of clinical centers cited in the included studies. We assessed the quality of selected studies using the Results: We included 20 studies (10 new and 10 updates of previously reviewed studies), with migraine being the most represented disease, and 12 upcoming trials. An emphasis on cognitive-behavioral therapy, biofeedback, and relaxation training still emerged, alongside a significant rise in eHealth solutions, particularly in upcoming trials, after the pandemic. Discussion: While the pandemic seems to have accelerated the adoption of eHealth for CH, the gap between research and clinical implementation of psychological intervention has not yet been effectively bridged.