For kids with migraines, therapy may be the best way to limit symptoms. In a new study from Cincinnati Children’s Hospital Medical Center, researchers show that cognitive behavioral therapy (CBT) can reduce the intensity and frequency of headaches much better than traditional headache education. The findings may lead to new palliative treatment strategies against the often debilitating condition.
While drug companies have developed a range of symptomatic reliefs for migraine sufferers, the majority of these medications cannot be prescribed to young people. Instead, physicians recommend stress reduction, yoga, counseling, and other activities that promote muscle relaxation. "In adults, more than 2 percent of the population has chronic migraine and in children and adolescents the prevalence is up to 1.75 percent,” the authors of the new study wrote. “In pediatric patients who seek care in headache specialty clinics, up to 69 percent have chronic migraine; however, there are no interventions approved by the U.S. Food and Drug Administration for the treatment of chronic migraine in young persons. As a result, current clinical practice is not evidence-based and quite variable."
Chronic Migraine and Cognitive Behavioral Therapy
The paper, which is published in the journal JAMA, sought to investigate whether CBT would provide better relief for children with chronic migraines. To do this, the researchers assessed symptom intensity and headache frequency in 135 subjects between 10 and 17 years of age. Each subject was then enrolled in a 10-session CBT program or a conventional headache education program. The CBT sessions included pain coping, relaxation techniques, as well as a so-called biofeedback component — a therapy method that educates a patient about muscle tension, heart rate, and other vital signs.
The researchers found that, on average, the CBT was nearly twice as effective as headache education. Whereas the treatment group reported 11.5 fewer headache days, the control only reported 6.8. Similarly, participants who received CBT recorded a significantly lower Pediatric Migraine Disability Assessment Score (PedMIDAS).
"Now that there is strong evidence for CBT in headache management, it should be routinely offered [to younger people] 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 researchers wrote. “Also, CBT should be made more accessible to patients by inclusion as a covered service by health insurance as well as testing of alternate formats of delivery, such as using online or mobile formats, which can be offered as an option if in-person visits are a barrier."
Migraines currently affect about 12 percent of the U.S. population. Aside from severe headache, symptoms typically include nausea, light sensitivity, and fatigue. Complications are often triggered by anxiety, stress, lack of food or sleep, exposure to light, as well as hormonal changes.