Chronic migraines in youth eased with therapy

Children and teens with chronic migraines showed fewer disabling headaches following a therapy that teaches coping skills, say doctors who'd like the therapy to be routinely offered to younger people along with medication.

Chronic migraines are frequent, severe, pulsating headaches accompanied by nausea, vomiting and sensitivity to light and sound.

Researchers in the United States randomly assigned 135 youth aged 10 to 17 with chronic migraines to 10 sessions of cognitive behavioural therapy that included pain coping training with biofeedback, or educational sessions that were the same length of time with a therapist.

All of the participants also received amitriptyline, an antidepressant that is also prescribed to prevent chronic headaches.

After 20 weeks, the number of days with headaches per month in the cognitive behavioural therapy (CBT) group decreased by 11.5 compared with a drop of 6.8 in the control group, Scott Powers of Cincinnati Children's Hospital Medical Center and his co-authors say in Wednesday's issue of the Journal of the American Medical Association.

"Now that there is strong evidence for CBT in headache management, it should be routinely offered as a first-line treatment for chronic migraine along with medications and not only as an add-on if medications are not found to be sufficiently effective," the study's authors conclude.

Of the 398 patients who were assessed to participate in the study, 226 refused to participate. They gave reasons such as the distance was too far, lack of time and a preference for standard clinical care, the researchers said.

Powers and his colleagues suggested testing whether offering the therapy online or in mobile formats helps to overcome barriers to in-person visits.

A total of 199 adverse events were reported, 90 in the CBT group and 109 in the education group. There were no differences between the two groups for the most severe events.

A journal editorial published with the study called it unique in its rigour among behavioural trials for treating pediatric chronic headaches.

The results provide "a compelling impetus to try" to surmount the barriers to implementing CBT for pediatric migraine cases, Mark Connelly of Children's Mercy Hospitals and Clinics in Kansas City said in the editorial.

The study was funded by the U.S. National Institute of Neurological Disorders and Stroke, the National Center for Research Resources, the National Center for Advancing Translational Sciences and the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.