Alterations in Brain Function After Cognitive Behavioral Therapy for Migraine in Children and Adolescents

Abstract

Objectives.-This basic mechanistic study examined the changes in brain activation and resting-state connectivity after 8 weeks of CBT in youth with migraine.Background.-Cognitive behavioral therapy (CBT) is a psychological intervention that is effective in reducing pain in migraine patients. However, the neural mechanisms underlying CBT in adolescents with migraine are not yet known.Methods.-Eighteen adolescents with migraine (15 females, age 15.1 ± 2.1 years [mean ± SD]) completed 8 weekly CBT sessions. Before the first and after the final CBT session, participants underwent structural and resting-state blood-oxygen-leveldependent contrast MRI scans. Arterial spin labeling was also used to examine brain activation during the resting state. For connectivity analyses, the right and left amygdala were chosen as seed regions. Relationships of the time courses within these seeds with voxels across the whole brain were evaluated.Results.-Headache frequency decreased from 15 ± 7.4 headaches per month before CBT to 10 ± 7.4 after CBT (P < .001). After CBT, greater brain activations in frontal regions involved in cognitive regulation of pain were found. In addition, after CBT increased connectivity between the amygdala and frontal regions was observed. Associations between brain activation and amygdalar connectivity with a reduction in headache frequency were also observed.Conclusions.-Alterations in brain function and amygdalar connectivity with areas involved in nociceptive processing, cognitive function, and emotional regulation may underlie the ability of CBT to aid in the prevention of headaches in migraine patients.

Spatial aspects of pain modulation are not disrupted in adolescents with migraine

“…Healthy control data were specifically collected for a preplanned comparison with quantitative sensory testing data derived from a study examining neural mechanisms underlying cognitive behavior therapy in adolescents with migraine. 33,34 Thus, this is a secondary analysis of the patients' data. For the current study, the pre-CBT assessment of PPT and CPM in adolescents with migraine was compared to healthy controls.…”

“…This study is a secondary analysis of a study that examined neural mechanisms underlying cognitive behavior therapy in adolescents with migraine. 33,34 The sample size for the patient group was based on the imaging part of the original study. For this preplanned secondary analysis, healthy controls were recruited.…”

Dissociation Between Individual Differences in Self-Reported Pain Intensity and Underlying Brain Activation

“…The dissociation between the subjective reports of pain and underlying brain activation raises significant questions about the ability of BOLD fMRI to serve as a biomarker for pain intensity. Thus, while fMRI may have significant potential to provide insight into mechanisms of chronic pain and potential trajectory of treatment responsivity [42][43][44][45][46][47] , the long-standing clinical dictum, "pain is what the patient says it is," remains and the use of fMRI as an objective measure to infer reported pain intensity for medico-legal purposes needs to be considered with great caution. The auditory stimuli were played using iTunes (Apple Inc, Cupertino, CA, USA).…”

Psychologische Kopfschmerztherapie in Zeiten von COVID-19

“…Hierzu finden Gewöhnungstrainings zur Veränderung der Reizempfindlichkeit, Verhaltensexperimente und das Einüben von Bewältigungsstrategien wie Reizabschirmung oder Entspannung Anwendung. Der Effekt dieses Ansatzes ist durch eine Reihe von Studien belegt [ 17 , 20 , 30 ].…”