Supportive Self-Management Program for People With Chronic Headaches and Migraine

Abstract

Background and Objectives:Chronic headache disorders are a major cause of pain and disability. Education and supportive self-management approaches could reduce burden of headache disability. We tested the effectiveness of a group educational and supportive self-management programme for people living with chronic headaches.Methods:A pragmatic randomised controlled trial. Participants were aged ≥18 years with chronic migraine or chronic tension type headache, with or without medication overuse headache.We primarily recruited from general practices. Participants were assigned to either a two-day group education and self-management programme, a one-to-one nurse interview, and telephone support or to usual care plus relaxation material.The primary outcome was headache related quality of life using the Headache Impact Test (HIT-6) at 12 months. The primary analysis used intention-to-treat principles for participants with migraine and both baseline and 12-month HIT-6 data.Results:Between April 2017 and March 2019, we randomised 736 participants. Since only nine participants just had tension type headache our main analyses were on the 727 participants with migraine. Of these 376 were allocated to the self-management intervention 351 to usual care. Data from 586 (81%) participants were analysed for primary outcome. There was no between group difference in HIT-6, (adjusted mean difference = -0·3, 95% CI -1·23 to 0·67), or headache days (0·9, 95% CI -0·29, 2·05), at 12 months. The CHESS intervention generated incremental adjusted costs of £268 (95% CI,£176 to £377) [USD383 (95%CI USD252 to USD539)] and incremental adjusted quality-adjusted life years (QALYs) of 0.031 (95% CI -0.005 to .063). The incremental cost-effectiveness ratio was £8,617 (USD12,322) per QALY gained.Discussion:These findings conclusively show a lack of benefit for quality of life or monthly headache days from a brief group education and supportive self-management programme for people living with chronic migraine or chronic tension type headache with episodic migraine.Registered on the International Standard Randomized Controlled Trial Number registry,ISRCTN7970810016th December 2015https://doi.org/10.1186/ISRCTN79708100The first enrolment was 24th April 2017.Classification of evidence:This study provides Class III evidence that a brief group education and self-management program does not increase the probability of improvement in headache related quality of life in people with chronic migraine.

Does pain self-efficacy predict outcomes in people with migraine; an exploratory analysis of the CHESS trial

“…The CHESS trial randomised 736 participants, including for these exploratory analyses nine participants with chronic tension type headache not included in our primary analyses; 356 (48%) to usual care and 380 (52%) to self-management. (14,15). Table 1 presents a brief demographics and characteristics at baseline.…”

“…The CHESS trial, and its results have been described in detail elsewhere. (14,15,17,19) Brie y, we recruited 736 people with chronic headaches to a parallel group randomised controlled trial of group supported self-management that included (2 group days) and a one-on-one headache classi cation interview and advice on drug treatment session (referred herein as CHESS intervention) from 166 general practices in England. Nine were excluded from our primary analysis because they had chronic tension type headache only.…”

“…(13) The same authors advocate the promotion of self-e cacy and an internal locus of control as rst-line non-pharmacological treatments for migraine. (13) In 2022, following a substantial amount of preparatory work we published a randomised controlled trial (N = 727) of an education and self-management support intervention for people with chronic headaches (chronic migraine + chronic tension type headache and episodic migraine) (14,15); the CHESS trial. The primary outcome was the Headache Impact Test − 6 (HIT-6) at 12 months.…”

Neues bei Kopfschmerzen 2022–2023

“…[48]. Eine weitere randomisierte Studie mit einer intensiven versus einer minimalen Verhaltenstherapie vermittelt durch eine "Kopfschmerzschwester" zeigte ebenfalls nur einen geringen therapeutischen Nutzen bei 179 untersuchten Patienten, die 12 Wochen nachverfolgt wurden [50]. Ziel der Studie war es, festzustellen, ob eine Migräneprophylaxe ohne Umstellung oder Begrenzung der Häufigkeit der Akutmedikation einer präventiven Migränetherapie mit Umstellung der Medikamente zur Therapie akuter Migräneattacken, die dann an <2 Tagen/Woche eingesetzt werden, nicht unterlegen ist.…”

Educational and Supportive Self-Management Program for the Treatment of Chronic Headache

“…In the study “Supportive Self-Management Program for People With Chronic Headaches and Migraine: A Randomized Controlled Trial and Economic Evaluation,” Underwood et al 1 looked at whether a group educational and supportive self-management program would benefit patients with chronic headache.…”