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Feasibility Assessment of Telephone-Administered Behavioral
Treatment for Adolescent Migraine
Cottrell C, Drew J, Gibson J, et al.
Posted: November 2007  
Headache 2007;47:1293-1302

Objectives:   To examine the feasibility of administering behavioral migraine management training by telephone (TAT) and the acceptability of TAT to adolescents with episodic migraine.

Methods:   34 adolescents were randomly assigned to a two-month telephone administered behavioral migraine management program or to a standard triptan treatment. Outcome was assessed at three and eight-month evaluations. Participants completed a daily migraine diary that yielded information about number, duration and severity of migraines and migraine-related disability. In addition, TAT participants evaluated key aspects of the TAT program. Lastly, the ability of adolescents to demonstrate specific headache management skills following TAT were assessed.

Results:   All fifteen adolescents who entered TAT successfully demonstrated either full or partial mastery of two or more skills and nearly half demonstrated at least partial mastery of all four skills evaluated. Ninety three percent of the TAT participants reported having a positive relationship with their phone counselor. They also reported a preference for the telephone-based treatment over in-clinic visits and rated the manual and tapes as helpful. Treatment effects (in terms of percent improvement) ranged from consistently large across both evaluations for improvement in number of migraines, disability equivalent hours and quality of life, to moderate or variable for migraine duration and severity. The triptan treatment group also showed clinically meaningful reductions in headache parameters and improvements in quality of life.

Conclusions:   Completion rates for TAT were high; adolescents evaluated their experience with TAT positively and were able to exhibit behavioral headache management skills following treatment. While clinically significant improvements in migraine and migraine-related disability-quality of life were observed with both TAT and treatment as usual (triptan therapy), the small study size and the absence of a control group do not permit conclusions about the effectiveness of either treatment. Nonetheless these results indicate TAT may be a promising treatment format for improving access to behavioral treatments for underserved adolescents and justifies further evaluation of TAT both alone and in combination with drug therapy.