OBJECTIVES: Severe, disabling headache is costly to individual sufferers, through pain and reduced functioning, and to society, through decreased work productivity and increased health care use. First-line prophylactic agents combined with triptans do not adequately benefit many disabled headache sufferers. We sought to investigate whether a cognitive-behavioral treatment targeting the psychological and behavioral factors that contribute to disabling headache may provide additional benefit and whether using a group format may provide a more intensive clinic-based treatment without increasing the cost of service delivery. DESIGN: We developed and piloted a cognitive-behavioral group treatment for chronic, disabling headache. We evaluated its effectiveness in decreasing headache, reducing symptomatic medication use, and improving quality of life. SETTING: A behavioral headache management program of an academic medical center. PATIENTS: Sixty-two individuals suffering from primary headache disorder with moderate to severe headache-related disability who completed treatment. INTERVENTIONS: Individuals completed a pretreatment evaluation, the 10-session cognitive-behavioral group treatment, and a 1-month-posttreatment evaluation. OUTCOME MEASURES: The impacts of treatment on headache (frequency, intensity, and duration), medication use, and quality of life were assessed. RESULTS: Separate multivariate analyses of variance revealed significant improvements in headache, symptomatic medication use, and quality of life. Overall, 50% of participants experienced at least a 50% reduction in headache frequency from pre- to posttreatment. CONCLUSIONS: The findings provide preliminary evidence that delivering a clinic-based, group-format cognitive-behavioral treatment to moderately to severely disabled headache sufferers can decrease headache activity, reduce symptomatic medication use, and improve quality of life.
OBJECTIVES: Severe, disabling headache is costly to individual sufferers, through pain and reduced functioning, and to society, through decreased work productivity and increased health care use. First-line prophylactic agents combined with triptans do not adequately benefit many disabled headache sufferers. We sought to investigate whether a cognitive-behavioral treatment targeting the psychological and behavioral factors that contribute to disabling headache may provide additional benefit and whether using a group format may provide a more intensive clinic-based treatment without increasing the cost of service delivery. DESIGN: We developed and piloted a cognitive-behavioral group treatment for chronic, disabling headache. We evaluated its effectiveness in decreasing headache, reducing symptomatic medication use, and improving quality of life. SETTING: A behavioral headache management program of an academic medical center. PATIENTS: Sixty-two individuals suffering from primary headache disorder with moderate to severe headache-related disability who completed treatment. INTERVENTIONS: Individuals completed a pretreatment evaluation, the 10-session cognitive-behavioral group treatment, and a 1-month-posttreatment evaluation. OUTCOME MEASURES: The impacts of treatment on headache (frequency, intensity, and duration), medication use, and quality of life were assessed. RESULTS: Separate multivariate analyses of variance revealed significant improvements in headache, symptomatic medication use, and quality of life. Overall, 50% of participants experienced at least a 50% reduction in headache frequency from pre- to posttreatment. CONCLUSIONS: The findings provide preliminary evidence that delivering a clinic-based, group-format cognitive-behavioral treatment to moderately to severely disabled headache sufferers can decrease headache activity, reduce symptomatic medication use, and improve quality of life.
Authors: Emmanouil K Symvoulakis; Lucy V Clark; Andrew J Dowson; Roger Jones; Leone Ridsdale Journal: Br J Gen Pract Date: 2007-03 Impact factor: 5.386