Adherence to Behavioral Therapy for Migraine: Knowledge to Date, Mechanisms for Assessing Adherence, and Methods for Improving Adherence

Gewirtz, Alexandra N.; Minen, Mia T.

doi:10.1007/s11916-019-0739-3

Cited by 18 publications

(14 citation statements)

References 53 publications

(51 reference statements)

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“…Interestingly, in two of the studies, MI pre-treatment did facilitate an increase in informal help seeking from parents and significant others. 37 Patients may want to engage in behavioral therapy but for reasons presented in this study (and similar previously published reasons) [see several of the recent reviews on this topic 3,38 ], there are too many other barriers, oftentimes external factors, preventing them from doing so. 3 Factors such as time and cost were themes across both the MI and TAU groups and likely account for the discrepancy between initiating behavioral therapy in the MI group and attending the session.…”

Section: Discussionmentioning

confidence: 70%

“…36 MI sessions as short as 15 minutes in length, performed as pretreatment, improved attendance for mental health treatment, and thus an increased uptake of mental health interventions. 37 Patients may want to engage in behavioral therapy but for reasons presented in this study (and similar previously published reasons) [see several of the recent reviews on this topic 3,38 ], there are too many other barriers, oftentimes external factors, preventing them from doing so. However, MI did not change the rate in which the patients in the MI arm actually scheduled or attended their behavioral therapy appointments relative to the TAU arm.…”

Section: Discussionmentioning

confidence: 71%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 71%

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

et al. 2020

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“…This is superior to what we observed, especially in weeks 5–8. There are no clear estimates of how much adherence influences treatment outcome, but lower adherence is believed to undermine the efficacy of behavioral interventions (Gewirtz & Minen, 2019). A study of app‐based progressive muscle relaxation as a prophylactic treatment for migraine in adults found that highly adherent users (defined as two or more session per week) had a significantly greater reduction in headache frequency than users with low adherence (Minen et al., 2019).…”

Section: Discussionmentioning

confidence: 99%

Self‐administered biofeedback treatment app for pediatric migraine: A randomized pilot study

et al. 2020

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Objective To investigate the effect size, safety, and tolerability of a therapist‐independent biofeedback treatment app among adolescent with migraine. Materials and Methods This was a prospective, 3:1 ratio randomized, sham‐controlled, double‐blind, pilot study with 16 adolescents diagnosed with migraine randomized to eight weeks of biofeedback treatment (n = 12) or sham biofeedback (n = 4), carried out at two university hospitals in Norway. The prespecified and primary objective of the study was to observe changes in outcomes within the active treatment group. The sham control group was included in a minor ratio primarily to evaluate its feasibility. The primary outcome was change in headache frequency. A modified intention to treat analysis was performed, including participants completing at least seven biofeedback sessions in weeks 1–4 (n = 12 vs. n = 4) and weeks 5–8 (n = 7 vs. n = 2). Results Adherence was poor with 40% (136/336) of planned biofeedback sessions completed during weeks 5–8. Within the biofeedback group, a not statistically significant reduction in headache frequency was observed at weeks 1–4 (2.92 days/month, 95% CI −1.00 to 6.84, p = .145) and weeks 5–8 (1.85 days/month, 95% CI −2.01 to 5.72, p = .395). The biofeedback group experienced a median of one fewer headache days/month versus sham that did not reach significance (95% CI −4.0 to 9.0, p = .760). Conclusions We observed a small reduction in headache frequency in the active treatment group. Findings were likely undermined by low adherence and underpowered analyses but indicate that a therapist‐independent biofeedback treatment app has the potential to be an effective, tolerable, and inexpensive treatment option.

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“…CBT-based mHealth apps have the potential to be used clinically to address a broader range of mental health conditions and are being investigated in clinical trials targeting conditions including postpartum depression, substance abuse, acrophobia, and migraine. [20][21][22][23] Preliminary data suggest there is no significant increase in adverse events with short-term use of CBT based digital therapeutics. As with other mHealth interventions further research is required to investigate whether successful clinical outcomes are sustainable long term.…”

Section: Digital Therapeuticsmentioning

confidence: 99%

What is the clinical value of mHealth for patients?

et al. 2020

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Despite growing interest from both patients and healthcare providers, there is little clinical guidance on how mobile apps should be utilized to add value to patient care. We categorize apps according to their functionality (e.g. preventative behavior change, digital self-management of a specific condition, diagnostic) and discuss evidence for effectiveness from published systematic reviews and meta-analyses and the relevance to patient care. We discuss the limitations of the current literature describing clinical outcomes from mHealth apps, what FDA clearance means now (510(k)/de novo FDA clearance) and in the future. We discuss data security and privacy as a major concern for patients when using mHealth apps. Patients are often not involved in the development of mobile health guidelines, and professionals' views regarding high-quality health apps may not reflect patients' views. We discuss efforts to develop guidelines for the development of safe and effective mHealth apps in the US and elsewhere and the role of independent app reviews sites in identifying mHealth apps for patient care. There are only a small number of clinical scenarios where published evidence suggests that mHealth apps may improve patient outcomes.

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Adherence to Behavioral Therapy for Migraine: Knowledge to Date, Mechanisms for Assessing Adherence, and Methods for Improving Adherence

Cited by 18 publications

References 53 publications

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

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

Self‐administered biofeedback treatment app for pediatric migraine: A randomized pilot study

What is the clinical value of mHealth for patients?

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