Abstract
Introduction. Multimodal approaches in behavioral treatment have gained recent interest, with proven efficacy for migraine. The utility of the Internet has been demonstrated for behavioral treatment of headache disorders, but not specifically for migraine. The aim of the study was to develop and evaluate an Internet-based multimodal behavior treatment (MBT) program for migraine and to test hand massage treatment as an adjunct.Methods. Eighty-three adults, 58 women and 25 men, with at least two migraine attacks a month were recruited via advertisements. An MBT program aiming at improvements in life-style and stress coping was developed for this study and, together with a diary, adapted for use over the Internet. Participants were randomized to MBT with and without hand massage and to a control group, and were followed for 11 months. Questionnaires addressing issues of quality of life (PQ23) and depressive symptoms (MADRS-S) were used.Results. A 50%, or greater, reduction in migraine frequency was found in 40% and 42% of participants of the two groups receiving MBT (with and without hand massage, respectively), who statistically were significantly more improved than participants in the control group. No effect of hand massage was detected, and gender did not show any independent contribution to the effect in a multivariate analysis.Conclusions. MBT administered over the Internet appears feasible and effective in the treatment of migraine, but no effect of hand massage was found. For increased knowledge on long-term effects and the modes of action of the present MBT program, further studies are needed.
Highlights
Multimodal approaches in behavioral treatment have gained recent interest, with proven efficacy for migraine
The inclusion criteria used for both studies were: fulfillment of migraine criteria according to the International Classification of Headache Disorders [30] and at least two migraine attacks monthly, as reported at the time of inclusion
Pairwise comparisons revealed that both treatment groups (A and B) had significantly higher proportions of participants who had reduced their migraine frequency by 50% or more compared to the control group (P = 0.022 and P = 0.031, respectively); no significant difference in reduction of migraine was seen between the two treatment groups A and B (Table III)
Summary
Multimodal approaches in behavioral treatment have gained recent interest, with proven efficacy for migraine. Multimodal behavioral modification programs utilize a holistic perspective [1] and aim at achieving broadbased cognitive and life-style changes They have demonstrated efficacy in the treatment of pain disorders [2,3,4,5,6], including headache [3,5,6], and have been the subject of increased interest during recent years [1].With regard to migraine, using a variety of behavior therapies, alone or mixed, such as cognitive therapies, life-style modifications, bio-feedback training, and relaxation training, has shown efficacy [7,8,9,10], and two studies have used a multimodal approach [9,10]. Concept of stress as a specific syndrome of bodily and mental reactions to unspecific strain; importance of cognitive processes for perceived stress; difference between acute and chronic stress; role of stress in migraine; importance of relaxation and sleep habits to mitigate stress reactions
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