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Trajectory of Improvement in Children and Adolescents With Chronic Migraine: Results From the Cognitive-Behavioral Therapy and Amitriptyline Trial

  • John W. Kroner
    Affiliations
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • James Peugh
    Affiliations
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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  • Susmita M. Kashikar-Zuck
    Affiliations
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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  • Susan L. LeCates
    Affiliations
    Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

    Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • Janelle R. Allen
    Affiliations
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

    Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • Shalonda K. Slater
    Affiliations
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio

    Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • Marium Zafar
    Affiliations
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • Marielle A. Kabbouche
    Affiliations
    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio

    Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

    Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • Hope L. O'Brien
    Affiliations
    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio

    Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

    Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • Chad E. Shenk
    Affiliations
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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  • Ashley M. Kroon Van Diest
    Affiliations
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • Andrew D. Hershey
    Affiliations
    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio

    Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

    Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • Scott W. Powers
    Correspondence
    Address reprint requests to Scott W. Powers, PhD, ABPP, FAHS, Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, MLC: 7039, 3333 Burnet Avenue, Cincinnati, OH 45229-3039.
    Affiliations
    Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio

    Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
    Search for articles by this author
Published:January 17, 2017DOI:https://doi.org/10.1016/j.jpain.2017.01.002

      Highlights

      • Cognitive behavioral therapy (CBT+A) reduced headache days within 2 months.
      • Decreases in headache days were seen as early as the first month of treatment.
      • More than 70% of CBT+A participants reduced their headaches days by 50% or more.
      • Within 5 months, more than 1/2 of CBT+A participants had 1 headache or less per week.
      • Doctors and patients can set goals for treatment expectations using these findings.

      Abstract

      We compared headache frequency trajectories between clinical trial participants who received cognitive-behavioral therapy (CBT) and amitriptyline (CBT+A) or headache education (HE) and amitriptyline (HE+A) to determine if there was a differential time course of treatment response between the groups. One hundred thirty-five patients (age 10–17 years) diagnosed with chronic migraine participated, attending 8 one-hour one-on-one CBT or HE sessions with a trained psychologist for 8 weekly sessions, 2 sessions at weeks 12 and 16, and a post-treatment visit at week 20. Participants kept daily headache diaries and completed take-home assignments between visits. Data from daily headache diaries are presented for each day and according to 28-day periods. Trajectories of improvement indicate initial decrease in headache days began during the first month of treatment, for both groups, and continued to decrease throughout treatment. The CBT+A group had greater daily improvement than the HE+A group. A significantly greater proportion of the CBT+A group had a ≥50% reduction in headache days each month, and a significantly greater proportion of the CBT+A group had ≤4 headache days per month in months 3 through 5. Results indicate the trajectory of decrease in headache days is significantly better for patients receiving CBT+A versus HE+A.

      Perspective

      This article presents daily information about headache frequency over a 20-week clinical trial. Youth with chronic migraine who received CBT+A improved faster than those in the control group. Findings provide clinicians with evidence-based expectations for treatment response over time and ways of monitoring treatment success.

      Trial registration

      clinicaltrials.gov identifier NCT00389038.

      Key words

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