Cognitive behavior therapy for comorbid migraine and/or tension-type headache and major depressive disorder: An exploratory randomized controlled trial

Abstract

Numerous studies have demonstrated comorbidity between migraine and tension-type headache on the one hand, and depression on the other. Presence of depression is a negative prognostic indicator for behavioral treatment of headaches. Despite the recognised comorbidity, there is a limited research literature evaluating interventions designed for comorbid headaches and depression. Sixty six participants (49 female, 17 male) suffering from migraine and/or tension-type headache and major depressive disorder were randomly allocated to a Routine Primary Care control group or a Cognitive Behavior Therapy group that also received routine primary care. The treatment program involved 12 weekly 50-min sessions administered by clinical psychologists. Participants in the treatment group improved significantly more than participants in the control group from pre-to post-treatment on measures of headaches, depression, anxiety, and quality of life. Improvements achieved with treatment were maintained at four month follow-up. Comorbid anxiety disorders were not a predictor of response to treatment, and the only significant predictor was gender (men improved more than women). The new integrated treatment program appears promising and worthy of further investigation.

Psychological Factors Associated With Chronic Migraine and Severe Migraine‐Related Disability: An Observational Study in a Tertiary Headache Center

“…CBT treatments to reduce depressive and anxious symptoms are similar in many ways, and yet also differ in scope and content when compared with CBT targeting migraine symptoms specifically. Recent literature has begun to address questions about how to modify existing CBT treatments to address people with migraine and comorbid psychiatric disorders (38). Intervention development efforts, and a series of early-stage randomized clinical trials, are warranted to identify potentially effective methods of addressing elevated psychiatric symptoms in people with migraine.…”

Cognitive‐Behavioral Therapy for Insomnia to Reduce Chronic Migraine: A Sequential Bayesian Analysis

“…Evidence to the contrary is accumulating, however. 38,39 Replicating these results in larger samples and with other comorbidities offers hope for a new era of treatment development, in which well-established behavioral interventions for both migraine and the comorbid condition are combined into a single integrated treatment that can be administered in conjunction with headache-specific pharmacotherapy. 38,39 Replicating these results in larger samples and with other comorbidities offers hope for a new era of treatment development, in which well-established behavioral interventions for both migraine and the comorbid condition are combined into a single integrated treatment that can be administered in conjunction with headache-specific pharmacotherapy.…”

Acceptance, Psychiatric Symptoms, and Migraine Disability: An Observational Study in a Headache Center

“…Fostering headache-related acceptance may thus be particularly important for people with migraine with high levels of depression and anxiety symptoms. Incorporating therapeutic methods such as Acceptance and Commitment Therapy 55 to enhance pain willingness (willingness to experience or endure migraine) and activity engagement (remaining engaged in valued activities despite migraine), such as through progressive exposure to headache stimuli or behavioral activation, 56,57 could be useful additions to existing well-established biobehavioral interventions including cognitive-behavioral treatments, biofeedback and relaxation training to reduce migraine-related disability, particularly among patients with depression and/or anxiety symptoms. 58 …”