Adding cognitive-behavioral therapy (CBT) to the treatment of migraines in children and adolescents resulted in greater reductions in headache frequency and migraine-related disability compared with headache education, according to a new study.
More than 2 percent of the adult population have chronic migraines, while in children and adolescents the prevalence is up to 1.75 percent, researchers report in the study, which was published in the Journal of the American Medical Association.
Up to 69 percent of pediatric patients who seek care in headache specialty clinics have chronic migraines. But there are no interventions approved by the U.S. Food and Drug Administration for the treatment of chronic migraines in young people, the researchers said.
“As a result, current clinical practice is not evidence-based and quite variable,” they noted.
For the study, Scott W. Powers, Ph.D., of Cincinnati Children’s Hospital Medical Center, and his colleagues recruited 135 patients between the ages of 10 and 17 diagnosed with chronic migraine — more than 15 days a month with a headache — and a Pediatric Migraine Disability Assessment Score (PedMIDAS) greater than 20 points. They randomly put 64 in a group that received CBT, while the remaining 71 received headache education.
Interventions consisted of 10 CBT or 10 headache education sessions involving the same time and therapist attention, the researchers explained. CBT included training in pain coping, including a biofeedback component. Each group also received amitriptyline.
Follow-up visits were conducted at three, six, nine, and 12 months.
On average, at the beginning of the trial, participants reported 21 of 28 days with a headache and a PedMIDAS of 68 points, indicating a severe grade of disability. From pre-treatment to post-treatment, CBT resulted in a decrease of 11.5 headache days compared to 6.8 days with headache education, the researchers found.
At the 12-month follow-up, 86 percent of CBT participants had a 50 percent or greater reduction in days with headache vs. 69 percent of the headache education group. The researchers also found that 88 percent of CBT participants had a PedMIDAS of less than 20 points (mild to no disability) vs. 76 percent of the headache education group.
“Now that there is strong evidence for CBT in headache management, it should be routinely offered [to younger people] 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,” the researchers noted in their study.
“Also, CBT should be made more accessible to patients by inclusion as a covered service by health insurance, as well as testing of alternate formats of delivery, such as using online or mobile formats, which can be offered as an option if in-person visits are a barrier.”
Source: The JAMA Network Journals