December 26, 2013
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Cognitive-behavioral therapy reduced headache frequency

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Cognitive-behavioral therapy resulted in greater reductions in headache frequency and migraine-related disability compared with headache education among children and adolescents with chronic migraine, according to recent study findings published in JAMA.

Scott W. Powers, PhD, of Cincinnati Children’s Hospital Medical Center, and colleagues evaluated 135 participants (79% female) aged 10 to 17 years diagnosed with chronic migraine and a Pediatric Migraine Disability Assessment Score (PedMIDAS) of more than 20 points to determine the effectiveness of cognitive-behavioral therapy (CBT) compared with headache education.

There was decrease of 11.5 days with headache with CBT compared with 6.8 days with headache education (P=.002). CBT also decreased the PedMIDAS by 52.7 points compared with 38.6 points with headache education (P=.01). Among the CBT group, 66% had a 50% or greater reduction in headache days compared with 36% of the headache education group (OR=3.45; 95% CI, 1.66-7.15). Also, 75% of the CBT group had a PedMIDAS of less than 20 points compared with 56% of the headache education group (OR=2.36; 95% CI, 1.1-5.1).

“Now that there is strong evidence for CBT in headache management, it should be routinely offered as a first-line treatment for chronic migraine along with medications and not only as an add-on if medications are not found to be sufficiently effective,” they wrote. “Also, CBT should be made more accessible to patients by inclusion as a covered service by health insurance as well as testing of alternate formats of delivery, such as using online or mobile formats, which can be offered as an option if in-person visits are a barrier.”

In an accompanying editorial, Mark Connelly, PhD, of Children’s Mercy Hospital and Clinics in Kansas City, Mo., wrote that system barriers could affect the likelihood of CBT being implemented as first-line treatment for chronic migraines.

“Despite potential system and family barriers to accessing CBT, providers seeing children and adolescents with chronic migraine (migraines occurring more than 15 days per month) should strongly consider recommending CBT along with a preventive medication as the treatment with the current best available evidence of efficacy for this condition,” he told Infectious Diseases in Children.by Amber Cox

Mark Connelly, PhD, can be reached at Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108; email: mconnelly1@cmh.edu.

For more information:

Powers SW. JAMA. 2013;doi:10.1001/jama.2013.282533.

Connelly M. JAMA. 2013;doi:10.1001/jama.2013.282534.

Disclosure: See study for a full list of disclosures.