Cognitive Behavioral Therapy for Chronic Migraine

Abstract

Research Article| March 01 2014 Cognitive Behavioral Therapy for Chronic Migraine AAP Grand Rounds (2014) 31 (3): 27. https://doi.org/10.1542/gr.31-3-27 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Cognitive Behavioral Therapy for Chronic Migraine. AAP Grand Rounds March 2014; 31 (3): 27. https://doi.org/10.1542/gr.31-3-27 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: amitriptyline, chronic migraine, cognitive-behavioral therapy, headache, migraine disorders Source: Powers SW, Kashikar-Zuck SM, Allen JR, et al. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA. 2013; 310(24): 2622– 2630; doi: https://doi.org/10.1001/jama.2013.282533Google Scholar Investigators at the Headache Center at Cincinnati Children’s Hospital conducted a randomized clinical trial to compare the efficacy of cognitive behavioral therapy (CBT) combined with amitriptyline to headache education plus amitriptyline for children with chronic migraine headaches. Youth 10 to 17 years old, with at least 15 headaches per month and a Pediatric Migraine Disability Assessment Score (PedMIDAS) >20, were randomized to either the CBT or headache education treatment group. Participants received 1 mg/kg of amitriptyline daily, and either 10 sessions of CBT or headache education. The main outcomes were reduction in number of headaches per 28 days and change in PedMIDAS scores. Outcomes were compared between the 2 groups at 20 weeks and 12 months postintervention. A total of 135 children and adolescents (79% female) were enrolled, and 124, including 57 in the CBT group and 67 in the headache education group, completed the study. At baseline, participants had a mean of 21 ± 5 days with headache per 28 days and a mean PedMIDAS of 68 points. At the 20-week end point, days with headache were reduced by 11.5 days for the CBT group versus 6.8 days for the education group (difference, 4.7; P = .002). The PedMIDAS decreased by 52.7 points for the CBT group versus 38.6 points for the education group (P = .01). In the CBT group, 66% of participants had a 50% or greater reduction in headache days versus 36% in the education group (OR = 3.5; P = .001). At 12-month follow-up, 86% of participants in the CBT group had a 50% or greater reduction in headache days versus 69% of participants in the education group; 88% of participants in the CBT group had a PedMIDAS of <20 points versus 76% in the headache education group. The authors conclude that use of CBT plus amitriptyline provides a greater reduction in days with headache and disability compared to headache education plus amitriptyline, in children and adolescents with chronic migraine. Dr Millichap has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Chronic migraine is defined as having at least 15 days of headache per month, with the majority of these characterized by moderate to severe intensity and pulsating quality, and associated with nausea, vomiting, phonophobia, and photophobia.1 No pharmacological intervention for chronic migraine in children is approved by the US Food and Drug Administration. Amitriptyline, a tricyclic antidepressant, is recommended for the prevention of migraine, based on open-label studies and meta-analysis.2 CBT, which includes coping skills training and biofeedback-assisted relaxation, has been shown to benefit children with chronic headache, including migraine.3 The benefits of CBT in childhood migraine may be... You do not currently have access to this content.