Brief cognitive-behavioral group treatment for children's headache. A randomized controlled trial of Internet-based self-help training for recurrent headache in childhood and adolescence. A comparison of psychological and pharmacological treatment of pediatric migraine. A behavioral treatment of young migrainous and nonmigrainous headache patients: prediction of treatment success. Cognitive-behavioral therapy of pediatric headache: are there differences in efficacy between a therapist-administered group training and a self-help format? Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain. Cognitive and relaxation treatment of paediatric migraine. Headstrong: a pilot study of a CD-ROM intervention for recurrent pediatric headache. Therapist-assisted versus self-help relaxation treatment of chronic headaches in adolescents: a school-based intervention.
Using a randomized design with a waiting list control condition, we assessed the effectiveness of an abbreviated cognitive therapy group program for headaches in children 7 to 12 years of age. In the treatment condition, small groups of five to eight children were taught relaxation, distraction, visualization, and stress management skills in two 90-minute sessions. Parent groups, seen concurrently, reviewed the children's program and addressed parenting strategies. The waiting list control groups were treated 5 weeks later. Thirty-six children meeting inclusion criteria were included in the study; complete data were available for 29 participants (mean age, 9.4 years; 66% female). DEPENDENT MEASURES: We obtained children's ratings of headache frequency, intensity, duration, and five other variables in a diary kept for 3 weeks before and 3 weeks after treatment. Parent measures were collected once before treatment and once at 3-month follow-up.
                CHILD RATINGS: The control condition showed a significant reduction in children's self-rated headache frequency, while the treatment condition did not. On all other self-reported variables, there were no significant differences between the control and treatment conditions. Two participants in each condition achieved a 50% or greater reduction in a self-rating headache index.
                PARENT RATINGS: Follow-up ratings, obtained over the telephone from parents after the children in both conditions had been treated, indicated that the children in both conditions had experienced reduced intensity, frequency, and duration of headaches and that 82% of the children were using the techniques taught in the program. Fourteen children achieved a 50% or greater reduction in a headache index based on parent ratings.
                Although parents were very positive about the effectiveness of the program, the results for children's self-ratings do not support the use of this highly abbreviated treatment method. Two different self-help training programs (multimodal cognitive-behavioral training (CBT) and applied relaxation (AR)) presented via the Internet were compared with an educational intervention (EDU) in an RCT. Sixty-five children and adolescents (mean age: 12.7 years) with recurrent headache (at least 2 attacks per month) were each assigned to one of the three treatment conditions. The main outcome variables related to changes in headache frequency, intensity and duration as well as the responder rate (50% reduction of headache frequency) and NNTs. Secondary outcome variables were pain catastrophizing and general well-being (depression, psychopathological symptoms and health-related quality of life). All groups showed significant reduction in headache frequency, duration and pain catastrophizing, but not in headache intensity, depression, psychopathological symptoms or health-related quality of life at post-assessment. NNTs were 2.0 for the comparison CBT and EDU; 5.2 for the comparison of AR and EDU at post-treatment. The highest responder rates at post were from CBT (63%), significantly different compared to AR (32%) and EDU (19%), whereas at follow-up no significant differences were found (CBT: 63%, AR: 56%, EDU: 55%) reflecting in the NNTs. The effects remain stable in headache frequency, pain catastrophizing and psychopathological symptoms across all groups at follow-up assessment. CBT showed the highest within-effect size in headache frequency, duration and pain catastrophizing. The results support the use of Internet programs for pediatric recurrent headache, especially given their accessibility and suitability for children and adolescents. Further studies are needed to improve their quality and efficacy.
                Copyright 2009 Elsevier Ltd. All rights reserved. A comparison was carried out of the efficacy of psychological and drug treatments for children with migraine. Forty-three children aged between 8 and 16 years (mean age: 11.3 years) who suffered from migraine received either progressive relaxation or cephalic vasomotor feedback, both with stress management training, or metoprolol, a beta-blocker. Psychological treatment was administered in ten sessions lasting six weeks and the drug treatment lasted ten weeks. Relaxation and stress management training reduced the headache index (frequency x intensity of headache episodes), more effectively than metoprolol with cephalic vasomotor feedback and stress management training in between. An overall improvement over time was found with regard to frequency and intensity of headache episodes and analgesics intake. When comparing pre- to post-treatment data, children treated with relaxation training improved significantly in headache frequency and intensity, whereas those treated with cephalic vasomotor feedback improved significantly in headache frequency and duration as well as mood. The clinical improvement was stable at an 8-months follow-up. We evaluated the outcome of a behavioral treatment package in a clinical setting with a group of young (age: 12-22) headache patients, suffering from migrainous or nonmigrainous. Comparison between the experimental (n = 24) and the waiting-list control group (n = 15) showed a treatment effect on headache frequency and on the headache index. Using a 50% reduction in the headache activity as a criterion for clinical improvement, 52% of the participants in the experimental group had improved clinically at the end of the treatment. The treated participants were found to have maintained significant improvement at 1-year follow-up. The treatment effect was significantly high for nonmigrainous headache patients than for migraineurs. The most important background predictor of outcome was duration of headache history: youngsters with a longer headache history profited less by the treatment than youngsters with a shorter headache history. Family predictors of pre-post improvement were maternal rewarding of illness behavior and mother-child relationship Those youngsters who reported more rewarding and/or a more positive mother-child relationship profited less by the treatment than those who reported less rewarding and/or a less positive mother-child relationship. We conclude that therapists treating young headache patients should be alert to pain-rewarding patterns in the family. The efficacy of cognitive-behavioral training in a therapist-administered group format (TG) and a self-help format (SH) for children with recurrent headache was compared.
                A total of 77 children (10-14 years) were randomly assigned to TG (n=29), SH (n=27) and a waiting-list control group (WC; n=19). TG consisted of eight 90-min sessions with groups of five children. SH was conducted via a written manual in which instructions were given and homework tasks were assigned. In both training formats, the topics covered were identical (e.g., self-monitoring of headache, trigger analysis, relaxation, etc.). Main outcome variables related to changes in headache intensity, duration and frequency as assessed with a diary prior to and following training, as well as at 6-month follow-up.
                Children reported a high degree of satisfaction with the training. No significant differences between the two conditions were found. Differences between treatment groups and WC were statistically corroborated for two headache variables. In both treatments, headache decreased markedly from posttraining to follow-up, with 68-76% of children reporting clinically significant improvement. No differential effects of age, gender or headache diagnosis were found. Changes in self-concept and ability to cope with stress after training point to further positive effects of the intervention.
                The efficiency of the two training formats is nearly identical. The group format, because of its better acceptance, is recommended for practical use. Cognitive-behavioral therapy (CBT) interventions show promise for decreasing chronic pain in youth. However, the availability of CBT is limited by many factors including distance to major treatment centers and expense. This study evaluates a more accessible treatment approach for chronic pediatric pain using an Internet-delivered family CBT intervention. Participants included 48 children, aged 11-17 years, with chronic headache, abdominal, or musculoskeletal pain and associated functional disability, and their parents. Children were randomly assigned to a wait-list control group or an Internet treatment group. Primary treatment outcomes were pain intensity ratings (0-10 NRS) and activity limitations on the Child Activity Limitations Interview, both completed via an online daily diary. In addition to their medical care, the Internet treatment group completed 8 weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies, and sleep and activity interventions. Youth randomized to the wait-list control group continued with the current medical care only. Findings demonstrated significantly greater reduction in activity limitations and pain intensity at post-treatment for the Internet treatment group and these effects were maintained at the three-month follow-up. Rate of clinically significant improvement in pain was also greater for the Internet treatment group than for the wait-list control group. There were no significant group differences in parental protectiveness or child depressive symptoms post-treatment. Internet treatment was rated as acceptable by all children and parents. Findings support the efficacy and acceptability of Internet delivery of family CBT for reducing pain and improving function among children and adolescents with chronic pain. The present study compared the efficacy of two active treatments, relaxation training and cognitive coping, with a non-specific placebo control in the treatment of 42 children and adolescents with migraine. The first treatment is a simplified version of progressive deep muscle relaxation; the second, a form of cognitive restructuring involving the alteration of dysfunctional thought processes. The results demonstrated that each active treatment was superior to the non-specific intervention in reducing overall headache activity and frequency but not duration or intensity. There were no differences between the experimental groups, and both continued to improve through a 16-week follow-up period, but the control group did not. Initial level of headache severity was an important factor in treatment outcome, with children with severe headaches responding better than those with milder headaches. Possible reasons for the differential treatment effects are discussed, and the implications for future research are considered. To empirically evaluate a minimal therapist contact CD-ROM pain management program for recurrent pediatric headache developed as part of this study.
                Participants were 37 children aged 7-12 attending a pediatric neurology clinic for evaluation of recurrent headache. Children who were randomly assigned to the treatment group worked through the CD-ROM program on home computers for 4 weeks following baseline assessment, whereas those assigned to the wait-list group continued following the prescriptions of their neurologist. Data on daily headache activity and headache-related disability were collected at baseline and up to 3 months after treatment.
                Children who received the adjunctive CD-ROM program had significant improvements in headache activity above and beyond those in the control group. Results provide initial support for the utility of adding an adjunctive CD-ROM psychological intervention to standard medical care for recurrent pediatric headache and potentially other chronic pain conditions in children. This study compared the relative efficacy of a therapist-assisted relaxation treatment programme with a self-help approach and a self-monitoring condition in the treatment of chronic headaches in adolescents within a school setting. The subjects were 46 high school students, 16-18 years of age, who were randomly assigned to the three treatment conditions. The results indicated that the self-help approach was as effective as the therapist-assisted relaxation condition in reducing the students' headache, and that these findings were maintained at a 5-month follow-up evaluation. The results suggest that the self-help relaxation procedure is a potential low-cost alternative treatment to a more traditional therapist-based intervention condition.
Psychological treatments are effective in reducing pain intensity for children and adolescents (<18 years) with headache and benefits from therapy appear to be maintained. Psychological treatments also improve pain and disability for children with non-headache pain. There is limited evidence available to estimate the effects of psychological therapies on mood for children and adolescents with headache and non-headache pain. There is also limited evidence to estimate the effects on disability in children with headache. These conclusions replicate and add to those of the previous review which found psychological therapies were effective in reducing pain intensity for children with headache and non-headache pain conditions, and these effects were maintained at follow-up.