Hypnotherapy or transcendental meditation versus progressive muscle relaxation exercises in the treatment of children with primary headaches: a multi-centre, pragmatic, randomised clinical study

Abstract

Many children suffer from headaches. Since stress may trigger headaches, effective techniques to cope with stress are needed. We investigated the effectiveness of two mind-body techniques, transcendental meditation (TM) or hypnotherapy (HT), and compared them with progressive muscle relaxation (PMR) exercises (active control group). Children (9–18 years) suffering from primary headaches more than two times per month received either TM (N = 42), HT (N = 45) or PMR (N = 44) for 3 months. Primary outcomes were frequency of headaches and ≥ 50% reduction in headaches at 3 and 9 months. Secondary outcomes were adequate relief, pain coping, anxiety and depressive symptoms, somatisation and safety of treatment. Groups were comparable at baseline. Headache frequency was significantly reduced in all groups from 18.9 days per month to 12.5 and 10.5 at respectively 3 and 9 months (p < 0.001), with no significant differences between the groups. Clinically relevant headache reduction (≥ 50%) was observed in 41% and 47% of children at 3 and 9 months respectively, with no significant differences between the groups. No differences were observed in secondary outcome measures between the intervention groups. No adverse events were reported.Conclusion: All three techniques reduced primary headache in children and appeared to be safe.Trial registration: NTR 2955, 28 June 2011 (www.trialregister.nl) What is Known: • Stress may be an important trigger for both tension type headache and migraine in children. • Good data are lacking on the effect of transcendental meditation, hypnotherapy or progressive muscle relaxation as possible stress-reducing therapies in children with primary headaches. What is New: • Three non-pharmacological techniques, i.e., transcendental meditation, hypnotherapy and progressive muscle relaxation exercises, all result in a clinically significant reduction of headaches and use of pain medication. • No large differences between the three techniques were found, suggesting that children can choose either one of the three techniques based on personal preferences.

Efficacy of relaxation therapy as an effective nursing intervention for post‑operative pain relief in patients undergoing abdominal surgery: A systematic review and meta‑analysis

“…De Paolis et al (30) found PMR with interactive imagery to be an effective adjuvant pain relief technique for terminal cancer patients. Jong et al (31) used PMR as an effective tool for pain relief in children with primary headaches.…”

Pragmatic trials of pain therapies: a systematic review of methods

“…Some trials excluded individual unrelated interventions, such as injections and surgery, 88 injections alone, 87 physiotherapy, 16 tricyclic antidepressants, 5 or pain medication (not further specified). 59 , 102 Only one drug trial made specific allowances for medications and dosages, including some of the same class as study interventions and opioids. 35 Another trial changed the regimen from allowing nonsteroidal anti-inflammatory drugs only in the first 6 weeks to applying no restrictions thereafter.…”

“…Only 7 trials (12%) were fully industry funded, 26 , 29 , 35 , 94 , 97 , 104 , 127 44 trials (77%) had public funders, and 5 (9%) were funded by mixed sources. 50 , 59 , 67 , 83 , 85 Funding sources were not reported in one trial. 91 Most trials were conducted in the United States (35%), followed by the United Kingdom (14%), Australia (7%), and Norway (7%).…”

Pharmaco-epidemiological research on herbal medicinal products in the paediatric population: data from the PhytoVIS study

“…Thus, the treatment of headache can be successful with non-pharmacological techniques, i.e. transcendental meditation, hypnotherapy and progressive muscle relaxation [17]. Further methods such as clown therapy also show surprisingly good effects in children, especially in anxiety [18].…”