A Pilot Randomized Controlled Trial to Assess the Impact of Motivational Interviewing on Initiating Behavioral Therapy for Migraine

Abstract

Background.-Relaxation, biofeedback, and cognitive behavioral therapy are evidence-based behavioral therapies for migraine. Despite such efficacy, research shows that only about half of patients initiate behavioral therapy recommended by their headache specialists.Objective.-Motivational interviewing (MI) is a widely used method to help patients explore and overcome ambivalence to enact positive life changes. We tested the hypothesis that telephone-based MI would improve initiation, scheduling, and attending behavioral therapy for migraine.Methods.-Single-blind randomized controlled trial comparing telephone-based MI to treatment as usual (TAU). Participants were recruited during their appointments with headache specialists at two sites of a New York City medical center. Inclusion criteria: ages from 16 to 80, migraine diagnosis by United Council of Neurologic Subspecialty fellowship trained and/or certified headache specialist, and referral for behavioral therapy for prevention in the appointment of recruitment. Exclusion criteria: having done behavioral therapy for migraine in the past year. Participants in the MI group received up to 5 MI calls. TAU participants were called after 3 months for general follow-up data. The prespecified primary outcome was scheduling a behavioral therapy appointment, and secondary outcomes were initiating and attending a behavioral therapy appointment.Results.-76 patients were enrolled and randomized (MI = 36, TAU = 40). At baseline, the mean number of headache days was 12.0 ± 9.0. Self-reported anxiety was present for 36/52 (69.2%) and depression for 30/52 (57.7%). Follow-up assessments were completed for 77.6% (59/76, MI = 32, TAU = 27). The mean number of MI calls per participant was 2.69 ± 1.56 [0 to 5]. There was a greater likelihood of those in the MI group to initiating an appointment (22/32, 68.8% vs 11/27, 40.7%, P = .0309). There were no differences in appointment scheduling or attendance. Reasons stated for not initiating behavioral therapy were lack of time, lack of insurance/funding, prioritizing other treatments, and travel plans.Conclusions.-Brief telephone-based MI may improve rates of initiation of behavioral therapy for migraine, but other barriers appear to lessen the impact on scheduling and attending behavioral therapy appointments.

Smartphone‐Delivered Progressive Muscle Relaxation for the Treatment of Migraine in Primary Care: A Randomized Controlled Trial

“…Furthermore, when referred for conventional in-person behavioral therapy for migraine, prior studies show that many people with migraine do not follow-up with the recommended intervention. 14,15 Participants have cited lack of accessibility (cost and time) as being the barrier to treatment. 15 Thus, the RELAXaHEAD intervention with PMR that people can do on their own without paying a provider is a potential solution for some patients to access care.…”

“…10,12,13 Furthermore, even when people are referred for behavioral therapy for migraine, few people attend the behavioral therapy appointments. 14,15 Time and cost are frequently cited by patients as barriers to pursuing behavioral therapy for migraine. 14,15 Effective, accessible, nonpharmacologic, prevention management strategies are needed to improve migraine management in the primary care setting.…”

“…14,15 Time and cost are frequently cited by patients as barriers to pursuing behavioral therapy for migraine. 14,15 Effective, accessible, nonpharmacologic, prevention management strategies are needed to improve migraine management in the primary care setting. The RELAXaHEAD smartphone application (app) was developed in collaboration with Irody 16 and beta-tested by both headache specialists and people with migraine.…”

Underuse of Behavioral Treatments for Headache: a Narrative Review Examining Societal and Cultural Factors

“…Specifically, we examined: (a) lack of knowledge regarding non-pharmacological treatment options among referring practitioners and headache patients; (b) the relatively limited number and distribution of clinicians trained in non-pharmacological headache treatments; (c) demographic-minority, socio-economic, and third-party payerrelated disparities in healthcare access; and (d) societal stigma associated with a diagnosis of headache, compounded by the stigma of referral to a perceived "psychiatric" treatment. We also present barriers identified by our team of experts (based on experiences and prior publications) [13][14][15][16][17] for both healthcare providers and patients, along with ways to overcome these barriers (Table 1). Using the Transtheoretical Model of Stages of Change, 18 we show how healthcare providers and patients may advance from one stage to the next to overcome barriers (Table 2).…”

Behavioral Therapy Preferences in People With Migraine

“…Time was cited as the most common barrier to initiating the behavioral therapy 5 . A randomized controlled study found that motivational interviewing increased the rates of inquiring about the behavioral therapy but not the rates of scheduling or attending therapy appointments 6 . Apprehension about the time commitment, cost, and difficulty accessing the treatment were cited as some of the barriers to scheduling/attending these appointments.…”