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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Methodological considerations in research with special populations: Children and adolescents.Headache. 2005; 45: 520-525
Asparouhov T, Muthén B: Multiple imputation with Mplus. MPlus Web Notes, 2010. Available at: https://www.statmodel.com/download/Imputations7.pdf. Accessed October 28, 2016.
- Controlling the false discovery rate - a practical and powerful approach to multiple testing.J R Stat Soc Series B Stat Methodol. 1995; 57: 289-300
- Primary chronic daily headache and its subtypes in adolescents and adults.Neurology. 2004; 63: 843-847
- Psychological therapies for the management of chronic and recurrent pain in children and adolescents.Cochrane Database Syst Rev. 2012; : CD003968
- Psychological therapies for the management of chronic and recurrent pain in children and adolescents.Cochrane Database Syst Rev. 2009; : CD003968
- Psychological therapies for the management of chronic and recurrent pain in children and adolescents.Cochrane Database Syst Rev. 2014; : CD003968
- Psychological therapies for the management of chronic and recurrent pain in children and adolescents.Cochrane Database Syst Rev. 2003; : CD003968
- The International Classification of Headache Disorders: 2nd edition.Cephalalgia. 2004; 24: 9-160
- Effectiveness of amitriptyline in the prophylactic management of childhood headaches.Headache. 2000; 40: 539-549
- Characterization of chronic daily headaches in children in a multidisciplinary headache center.Neurology. 2001; 56: 1032-1037
- PedMIDAS: Development of a questionnaire to assess disability of migraines in children.Neurology. 2001; 57: 2034-2039
- Methodological issues in clinical trials of drug and behavior therapies.Headache. 2005; 45: 487-492
- Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: A multisite, single-blind, randomized, controlled clinical trial.Arthritis Rheum. 2012; 64: 297-305
- Associated Symptoms of Chronic Migraine in Children and Adolescents.University of Cincinnati, Cincinnati2015
- Cognitive behavioral therapy plus amitriptyline for children and adolescents with chronic migraine reduces headache days to ≤4 per month.Headache. 2016; 56: 711-716
- Prevalence and burden of chronic migraine in adolescents: Results of the chronic daily headache in adolescents study (C-dAS).Headache. 2011; 51: 693-706
Muthén LK, Muthén BO: Mplus user's guide (7th ed.). Los Angeles, CA, Muthén & Muthén, 1998-2015
- Guidelines for trials of behavioral treatments for recurrent headache, first edition: American Headache Society Behavioral Clinical Trials Workgroup.Headache. 2005; 45: S110-S132
- Trial of amitriptyline, topiramate, and placebo for pediatric migraine.N Engl J Med. 2017; 376: 115-124
- Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: A randomized clinical trial.JAMA. 2013; 310: 2622-2630
Schafer JL: Multiple Imputation With PAN. In: Collins LM, Sayer A (eds.): New methods for the analysis of change. Washington, DC, American Psychological Association, 2001, p. 357-377
- Computational strategies for multivariate linear mixed-effects models with missing values.J Comput Graph Stat. 2002; 11: 437-457
- Guidelines for controlled trials of drugs in migraine: Third edition. A guide for investigators.Cephalalgia. 2012; 32: 6-38
- Flexible Imputation of Missing Data.Chapman & Hall/CRC Press, Boca Raton, FL2012
Van Buuren S: Multiple imputation of multilevel data. In: Hox JJ, Roberts JK (eds.): Handbook of advanced multilevel analysis. New York, Routledge/Taylor & Francis Group, 2011, p. 173-196
Article info
Publication history
Published online: January 17, 2017
Accepted:
January 4,
2017
Received in revised form:
November 7,
2016
Received:
July 20,
2016
Footnotes
This work was supported by the National Institutes of Health (grant numbers R01NS050536; T32DK063929; UL1TR000077).
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2017 by the American Pain Society
