Feasibility Assessment of Telephone‐Administered Behavioral Treatment for Adolescent Migraine

Abstract

Objectives-To examine the feasibility of administering behavioral migraine management training by telephone (TAT) and the acceptability of TAT to adolescents with episodic migraine.Methods-34 adolescents (M = 14 years) with migraine (M = 3.6 migraines/month; M = 29.2 hours duration) were randomly assigned to a two-month telephone administered behavioral migraine management program (TAT) or to a standard Triptan Treatment (TT). Outcome was assessed at three-and eight-month evaluations. Participants completed a daily migraine diary that yielded information about number, duration and severity of migraines and migraine-related disability, as well as the Migraine Specific Quality of Life Questionnaire -Adolescent. In addition, TAT participants evaluated key aspects of the TAT program using 5-point Likert-like rating scales. Lastly, the ability of adolescents to demonstrate specific headache management skills following TAT was assessed.Results-All fifteen adolescents who entered TAT successfully demonstrated either full or partial mastery of two or more skills and nearly half demonstrated at least partial mastery of all four skills evaluated. Ninety three percent of the TAT participants reported having a positive relationship with their phone counselor. They also reported a preference for the telephone-based treatment over inclinic visits and rated the manual and tapes as helpful. Treatment effects (in terms of percent improvement) ranged from consistently large across both evaluations for improvement in number of migraines (54% and 71%), disability equivalent hours (80% and 63%) and quality of life (44% and 48%), to moderate or variable for migraine duration (35% and 23%) and severity (30% and 34%). The TT group also showed clinically meaningful reductions in headache parameters and improvements in quality of life.Conclusions-Completion rates for TAT were high; adolescents evaluated their experience with TAT positively and were able to exhibit key behavioral headache management skills following treatment. While clinically significant improvements in migraine and migraine-related disability/ quality of life were observed with both TAT and treatment as usual (triptan therapy), the small study size and the absence of a control group do not permit conclusions about the effectiveness of either treatment. Nonetheless these results indicate TAT may be a promising treatment format for improving access to behavioral treatments for underserved adolescents and justifies further evaluation of TAT both alone and in combination with drug therapy. Of the almost 28 million Americans reported to suffer the disabling effects of migraine headaches, it has been estimated that 10% are adolescents. 1-4 Migraine is among the most common maladies experienced by adolescents, with prevalence estimates ranging from 3% to 14%. 5,6 Beyond the pain and discomfort headaches produce approximately 1 million missed school days each year. 7 Adolescent migraines may remit, but often continue or reoccur in adulthood 2,8,9 and, in some individual...

A randomized trial of telephone-based motivational interviewing for adolescent chronic headache with medication overuse

“…We caution readers that while more completed MI calls were associated with lower headache frequency at follow-up, our restricted range of number of completed MI phone calls (from one to four) may have influenced this finding. In addition, our results are consistent with a non-MI study that indicated high completion rates for adolescents with headaches who are offered telephone-based assistance (19). Nevertheless, our brief intervention may be beneficial only for those with lower headache burden with their chronic migraine þ MOH/CTTH þ MOH.…”

Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents

“…Five trials investigated psychological therapies delivered remotely for children with headache (Connelly 2006; Cottrell 2007; McGrath 1992; Rapoff 2014; Trautmann 2010), one assessed juvenile idiopathic arthritis (Stinson 2010), and two included headache and non-headache conditions (i.e. recurrent abdominal pain and musculoskeletal pain) meaning that we entered them in both headache and mixed pain analyses where appropriate (Hicks 2006; Palermo 2009).…”

“…For Trautmann 2010, we combined two remotely delivered treatment conditions (cognitive behavioural therapy and applied relaxation) and compared this to the control condition (education). Most treatments were delivered via the Internet (Hicks 2006; Palermo 2009; Stinson 2010; Trautmann 2010), two studies delivered treatment via CD-ROM (Connelly 2006; Rapoff 2014), one study delivered treatment via audiotapes (McGrath 1992), and the remaining study delivered treatment primarily via the telephone (Cottrell 2007). Control conditions differed between studies.…”

Recent developments in pediatric headache

“…The study of these techniques is limited. A study using telephone-assisted behavioral therapy demonstrated an improvement in 34 adolescents after 3 and 8-month periods [67]. A separate study has begun to address the feasibility of using a CD-ROM to teach this behavioral therapy [68].…”