Researchers at Cincinnati Children’s Hospital have found that children taking amitriptyline and completing a 20 week course of cognitive-behavioral therapy had a reduction in headache days compared to children who were treated with amitriptyline and attended a headache education course.

“Our trial demonstrates, for the first time, a clinically meaningful and durable improvement for youth with chronic migraine in a rigorous trial,” said lead author Scott W. Powers, PhD, co-director, the Headache Center, Cincinnati Children’s Hospital.

“Cognitive-behavioral therapy should be a first-line treatment with preventive medication. Our job is to advocate for more research, coverage of this therapy by insurance, and education of healthcare providers so that this effective treatment is accessible and available regardless of family circumstances,” Dr. Powers added.

The kids in the cognitive-behavioral therapy group received a biofeedback-assisted relaxation component during which they learned to create a physical state of relaxation through deep breathing, muscle relaxation, and guided imagery. They also learned how pain works, and how it can be influenced by emotions and behavior. And, they learned various coping skills, and parents praised and reinforced the kids when they used their newly learned skills.

The educational group had regular discussions on headache-related topics. Kids in both groups received amitriptyline.

With almost 9 of 10 participants seeing measured changes, the cognitive-behavioral group had a 50% or more reduction in headache days and disability was reduced to a little to none level, by the end of the follow-up. Said Dr. Powers: “The trial demonstrates that cognitive behavioral therapy has a clinically meaningful impact on outcomes.” The study is published in the December 25th issue of JAMA.      Medscape  12/24/13

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