Behavioral Change Can Reduce Migraine Pain, Frequency

This article was originally posted on RealClearScience.

Migraine sufferers will do almost anything to prevent or reduce the pain of migraines. Different techniques seem to work for different people. For me, drinking coffee, laying down in a dark and quiet room or taking a hot shower is often helpful. If those methods don’t work, there are also many effective medications, such as sumatriptan and eletriptan. However, life would be much better if there was a more systematic, evidence-based approach to preventing migraines in the first place.

Now, a team of researchers from Cincinnati Children’s Hospital and the University of Cincinnati report in JAMA that cognitive behavioral therapy (CBT) combined with amitriptyline (a type of antidepressant) is quite effective at reducing both the severity and frequency of migraines in children aged 10-17.

The authors recruited children who were chronic migraine sufferers; i.e., kids who had at least 15 headaches per month. They were randomly assigned to one of two treatment groups: CBT (treatment) or headache education (control). Both groups were also given amitriptyline. The headache education group was supplied with information about headaches, while the CBT group was instructed on relaxation techniques and other pain management skills. The results of their experiment are shown below:

Children who received amitriptyline and CBT experienced fewer days with headaches (Panel A) and reduced disability due to migraine pain (Panel B). For ethical and practical reasons, the authors did not examine whether CBT alone (i.e., without amitriptyline) could be equally effective.

The take-home message from this research is quite clear: Teaching children who are chronic migraine sufferers basic relaxation and pain management skills has the potential to greatly improve their lives. Furthermore, these are skills they can carry with them into adulthood.

The trick, however, will be getting patients into the psychologist’s office where they can be taught CBT. Many people simply have neither the time nor inclination to do so.

Source: Scott W. Powers et al. “Cognitive Behavioral Therapy Plus Amitriptyline for Chronic Migraine in Children and Adolescents.” JAMA 310 (24): 2622-2630. (2013) doi:10.1001/jama.2013.282533.