Cognitive Behavioral Therapy may Help Relieve Pediatric Migraines

A recent study shows that for children and adolescents suffering from chronic migraines, cognitive behavioral therapy (CBT) may help with a reduction in headache frequency compared to headache education alone. 

"In adults, more than 2 percent of the population has chronic migraine and in children and adolescents the prevalence is up to 1.75 percent. In pediatric patients who seek care in headache specialty clinics, up to 69 percent have chronic migraine; however, there are no interventions approved by the U.S. Food and Drug Administration for the treatment of chronic migraine in young persons. As a result, current clinical practice is not evidence-based and quite variable," background information from the article notes, via a press release.

Lead study author Scott W. Powers, Ph.D., of Cincinnati Children's Hospital Medical Center, and colleagues randomized 135 participants between the ages of 10 and 17 years old, all of whom were diagnosed with chronic migraine and a Pediatric Migraine Disability Assessment Score of greater than 20 points. Children with this score are in the mild headache range, according to information from the disability score range.

The study was conducted in the Headache Center at Cincinnati Children's Hospital between October 2006 and September 2012. Of those involved, 129 participants were asked to complete a 20-week follow-up, 124 of whom did so. The interventions "consisted of 10 CBT or 10 headache education sessions involving equivalent time and therapist attention; CBT included training in pain coping, modified to include a biofeedback component. Each group received amitriptyline; follow-up visits were conducted at 3, 6, 9, and 12 months."

Findings showed that 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 pretreatment to posttreatment, CBT resulted in a decrease of 11.5 headache days vs. 6.8 days with headache education. At 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; 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. 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," the authors write, courtesy of the release.

More information regarding the study can be found via the JAMA Network Journals.