Pain and Symptom Consult: Helping Adolescents Manage Migraine Headaches

Abstract

Migraine headaches are fairly common among teenagers: estimates of prevalence rates range upward from 3.9 percent for teenage boys and 6.2 percent for teenage girls(1). Drug therapy has reportedly met with some success in controlling the pain, but research is sketchy because of subjectrecruitment difficulties and compliance problems. A variety of stress-reduction techniques have also been used to reduce the severity and frequency of adolescents' headaches(2,3). At the Children's Hospital of Eastern Ontario in Ottawa, we developed a treatment program for migraine headaches involving cognitive and behavioral strategies for managing stress. Adolescents who participate in the program are first screened by a neurologist. Only those with common migraine (not migraine related to dietary, menstrual, or pathological problems) can enter the program. The therapist for the program may be a psychologist, a nurse, a physician, a school counselor, a social worker, or other health professional. During the initial interview, the therapist discusses what will be expected of the adolescent, then allows him (her) to choose whether he wants to participate. Over eight weekly sessions, the therapist teaches the teenagers ten stress-reducing strategies. Throughout therapy, the teens monitor the frequency, duration, and severity of their headaches so they can gauge their progress. They keep a headache diary so the information is recorded systematically and is available for the therapist to see. After a teen has learned to use all ten strategies and has practiced each thoroughly, he (she) chooses those that work best. We round out