Randomized Controlled Trial of the Acceptability, Feasibility, and Preliminary Effects of a Cognitive Behavioral Skills Building Intervention in Adolescents With Chronic Daily Headaches: A Pilot Study

Abstract

Introduction The treatment challenge of adolescents with chronic daily headaches (CDHs) creates an urgent need for evidence-based interventions. Therefore, the purpose of this pilot study was to evaluate the acceptability, feasibility, and preliminary effects of a brief cognitive behavioral skills building intervention (CBSB) with thirty-six, 13-17 year-old, adolescents with CDHs and mild to moderate depressive symptoms. Methods Participants were randomly assigned either to the Creating Opportunities for Personal Empowerment Headache Education Program (COPE-HEP) or to a headache education comparison group. Results Adolescents and parents found the COPE-HEP to be highly acceptable. Medium to large positive effects were demonstrated on the adolescents’ depression in both groups and on anxiety and beliefs in the COPE-HEP group. COPE-HEP offered additional benefits of a larger decrease in adolescent anxiety over time and stronger beliefs in the teens’ ability to manage their headaches. Discussion Adolescents with CDHs and elevated depressive and anxiety symptoms should be offered headache hygiene education plus cognitive-behavioral skills building interventions. A full-scale trial to determine the more long-term benefits of COPE-HEP is now warranted.

Behavioral Approaches for Primary Headaches: Recent Advances

“…11,18,59 Third, and specifically addressing one of the patients' most frequent objections, the behavioral treatments discussed above are absent the side effects and contraindications that are often associated with certain pharmacological prophylactic treatments. 28,[31][32][33][34][35][36]62 The joint effect of these factors may reduce clinical symptoms by enhancing the way in which patients experience pain perception and intensity. As research progresses we are learning that no single causative effect is sufficient.…”

“…As research progresses we are learning that no single causative effect is sufficient. 31,32,34,46,[66][67][68][69] Improvement in the above-mentioned abilities likely further enhances pain coping strategies and simultaneously promotes reductions in catastrophizing about pain. Behavioral treatments produce reductions in stress, 35,42,60,61 increased sense of self-efficacy (ie, the confidence in one's ability to manage different aspects of his/her life), and reductions in the external locus of control (ie, the belief that one has limited to no ability to control life events).…”

“…30,33,34 One study did not report significance in their follow-up analysis, 37 2 did not report follow-up headache frequency, 40,42 and 2 did not report headache frequency at all. 32,35 Studies performed on adult populations showed contrasting results with regard to headache frequency reduction, which was significant in 5 studies only. 28,38,41,43,44 Improvements in some patient-reported outcomes were also found, including disability, 28,31,40,41 which was measured with the Migraine Disability Assessment (MIDAS) 51 and the World Health Organization (WHO) Disability Assessment Schedule (WHO-DAS 2.0), 52 self-efficacy 28,34,35 as measured with the Headache Management Self-Efficacy Scale (HMSE), 53 and QoL 28,34,44 as measured with the Migraine-Specific Quality of Life Questionnaire (MSQOL).…”

“…28,41 Other outcomes that were less consistently addressed included intake of medications, which decreased by 20-25%, 28,37 locus of control, improved by 10-18%, 28,34 depression and stress, decreased by 4-12%, 35 anxiety, decreased by 34%, 40 pain catastrophizing, decreased by 24-32%, 35,36,38 pain acceptance, improved by 13%, 36 and pain coping, improved by 6-18%. 36,38 Five studies used CBT in samples of children with different headache types, 29,[31][32][33]39 3 of which focused only on children with a diagnosis of chronic headaches/chronic migraine. 29,32,39 In 2 trials, participants were assigned to either CBT plus amitriptyline or a headache education program plus amitriptyline, 28,39 whereas in the other 3 studies the intervention group was compared with a headache education program or control group.…”

“…36,38 Five studies used CBT in samples of children with different headache types, 29,[31][32][33]39 3 of which focused only on children with a diagnosis of chronic headaches/chronic migraine. 29,32,39 In 2 trials, participants were assigned to either CBT plus amitriptyline or a headache education program plus amitriptyline, 28,39 whereas in the other 3 studies the intervention group was compared with a headache education program or control group. The headache education programs basically served as control group and were either provided by skilled professionals or with a CD-ROM (Rapoff et al's study), 33 and covered contents on general headache education, including triggers, and management of pharmacological therapies.…”