Cognitive behavioral therapy (CBT) resulted in greater reductions in headache frequency and migraine-related disability in children and adolescents with chronic migraine, according to researchers.
The study, conducted by Scott W. Powers, PhD, and his team at Cincinnati Children’s Hospital Medical Center found that adding biofeedback, relaxation techniques, and stress reduction to amitriptyline therapy reduced the number of migraine days and disability and had a favorable and clinically meaningful impact on children’s school functioning. “Now that there is strong evidence for CBT in headache management, we believe it should be offered routinely 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,” said Dr. Powers.
In the study, the team randomized 135 participants ages 10 to 17 diagnosed with chronic migraine with a Pediatric Migraine Disability Assessment Score (PedMIDAS) greater than 20 points to CBT (n = 64) or headache education (n = 71). Interventions consisted of 10 CBT or 10 headache education sessions involving equivalent time and therapist attention; CBT included training in pain coping, including a biofeedback component. Each group received amitriptyline. Follow-up visits were conducted at three, six, nine, and 12 months. At 12-month follow-up, 86% of CBT participants had a 50% or greater reduction in days with headache versus 69% of the headache education group; 88% of CBT participants had a PedMIDAS of less than 20 points (mild to no disability) versus 76% of the headache education group.
“While this is very good news as a study finding, translating this into clinical practice in treating young people with chronic migraine is an enormous challenge,” said Lawrence Newman, MD, President of the American Headache Society. “Treatment specialists will need to find ways to overcome adolescent resistance to behavioral therapy and insurance coverage issues for add-on treatment,” he said.