(515) Randomized controlled trial of a web-based behavioral treatment for pediatric headache

Abstract

Headache is among the most common pain complaints of childhood. Behavioral interventions are efficacious for improving pain among youth with headache. However, many youth do not receive psychological treatment for headache, which has led to consideration of alternative delivery modalities such as the Internet. We evaluated the efficacy of a family-based Internet behavioral treatment, called Web-Based Management of Adolescent Pain (Web-MAP), in 94 youth with headache (migraine, tension-type and other) receiving treatment in an interdisciplinary headache clinic. Adolescents were 11-17 years (M = 14.51) and 82% female, and were randomized to standard care (SMC; n = 42) or Web-MAP (n = 52). All participants completed pre-treatment assessments; 82% completed immediate post-treatment assessments (nSMC = 35; nWeb-MAP = 42). Primary treatment outcomes were pain intensity (0-10 NRS), headache days, and activity limitations (Child Activity Limitations Interview) completed via 7-day online diaries. In addition to standard care from the headache clinic, the Web-MAP group completed 8 weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies, and lifestyle interventions. The SMC group continued with standard headache care. Findings from baseline-adjusted ANCOVAs showed no significant group differences at post-treatment on pain intensity, F(1, 74) = 0.17, p = 0.68, headache days, F(1, 74) = 0.10 p = 0.75, or activity limitations, F(1, 74) = 0.36, p = 0.55. Paired t-tests with Bonferroni correction (α = .008) were used to examine within-group changes from pre- to post-treatment. The Web-MAP group showed significant improvement on activity limitations, t(41) = 3.59, p = 0.001, but not pain intensity, t(41) = 2.58, p = .01, or headache days, t(41) = 2.32, p = 0.03. The SMC group did not show significant improvement on any outcomes. Initial findings suggest Web-MAP can lead to reductions in activity limitations among youth with headache. Headache is among the most common pain complaints of childhood. Behavioral interventions are efficacious for improving pain among youth with headache. However, many youth do not receive psychological treatment for headache, which has led to consideration of alternative delivery modalities such as the Internet. We evaluated the efficacy of a family-based Internet behavioral treatment, called Web-Based Management of Adolescent Pain (Web-MAP), in 94 youth with headache (migraine, tension-type and other) receiving treatment in an interdisciplinary headache clinic. Adolescents were 11-17 years (M = 14.51) and 82% female, and were randomized to standard care (SMC; n = 42) or Web-MAP (n = 52). All participants completed pre-treatment assessments; 82% completed immediate post-treatment assessments (nSMC = 35; nWeb-MAP = 42). Primary treatment outcomes were pain intensity (0-10 NRS), headache days, and activity limitations (Child Activity Limitations Interview) completed via 7-day online diaries. In addition to standard care from the headache clinic, the Web-MAP group completed 8 weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies, and lifestyle interventions. The SMC group continued with standard headache care. Findings from baseline-adjusted ANCOVAs showed no significant group differences at post-treatment on pain intensity, F(1, 74) = 0.17, p = 0.68, headache days, F(1, 74) = 0.10 p = 0.75, or activity limitations, F(1, 74) = 0.36, p = 0.55. Paired t-tests with Bonferroni correction (α = .008) were used to examine within-group changes from pre- to post-treatment. The Web-MAP group showed significant improvement on activity limitations, t(41) = 3.59, p = 0.001, but not pain intensity, t(41) = 2.58, p = .01, or headache days, t(41) = 2.32, p = 0.03. The SMC group did not show significant improvement on any outcomes. Initial findings suggest Web-MAP can lead to reductions in activity limitations among youth with headache.