Trajectory of Improvement in Children and Adolescents With Chronic Migraine: Results From the Cognitive-Behavioral Therapy and Amitriptyline Trial

John W. Kroner, James Peugh, Susmita M. Kashikar-Zuck, Susan L. LeCates, Janelle R. Allen, Shalonda K. Slater, Marium Zafar, Marielle A. Kabbouche, Hope L. O'Brien, Chad E. Shenk, Ashley M. Kroon Van Diest, Andrew D. Hershey, Scott W. Powers

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

We compared headache frequency trajectories between clinical trial participants who received cognitive-behavioral therapy (CBT) and amitriptyline (CBT+A) or headache education (HE) and amitriptyline (HE+A) to determine if there was a differential time course of treatment response between the groups. One hundred thirty-five patients (age 10–17 years) diagnosed with chronic migraine participated, attending 8 one-hour one-on-one CBT or HE sessions with a trained psychologist for 8 weekly sessions, 2 sessions at weeks 12 and 16, and a post-treatment visit at week 20. Participants kept daily headache diaries and completed take-home assignments between visits. Data from daily headache diaries are presented for each day and according to 28-day periods. Trajectories of improvement indicate initial decrease in headache days began during the first month of treatment, for both groups, and continued to decrease throughout treatment. The CBT+A group had greater daily improvement than the HE+A group. A significantly greater proportion of the CBT+A group had a ≥50% reduction in headache days each month, and a significantly greater proportion of the CBT+A group had ≤4 headache days per month in months 3 through 5. Results indicate the trajectory of decrease in headache days is significantly better for patients receiving CBT+A versus HE+A. Perspective This article presents daily information about headache frequency over a 20-week clinical trial. Youth with chronic migraine who received CBT+A improved faster than those in the control group. Findings provide clinicians with evidence-based expectations for treatment response over time and ways of monitoring treatment success. Trial registration clinicaltrials.gov identifier NCT00389038.

Original languageEnglish (US)
Pages (from-to)637-644
Number of pages8
JournalJournal of Pain
Volume18
Issue number6
DOIs
StatePublished - Jun 2017

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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    Kroner, J. W., Peugh, J., Kashikar-Zuck, S. M., LeCates, S. L., Allen, J. R., Slater, S. K., Zafar, M., Kabbouche, M. A., O'Brien, H. L., Shenk, C. E., Kroon Van Diest, A. M., Hershey, A. D., & Powers, S. W. (2017). Trajectory of Improvement in Children and Adolescents With Chronic Migraine: Results From the Cognitive-Behavioral Therapy and Amitriptyline Trial. Journal of Pain, 18(6), 637-644. https://doi.org/10.1016/j.jpain.2017.01.002