Monday, November 26, 2018

Hybrid cognitive-behavioral therapy for adolescents with co-occurring migraine and insomnia

Law EF, Wan Tham S, Aaron RV, Dudeney J, Palermo TM. Hybrid Cognitive-Behavioral Therapy Intervention for Adolescents With Co-Occurring Migraine and Insomnia: A Single-Arm Pilot Trial. Headache. 2018 3Jul;58(7):1060-1073.


This study aimed to evaluate feasibility and acceptability of a hybrid cognitive-behavioral therapy intervention for adolescents with co-occurring migraine and insomnia.

Many youth with chronic migraine have co-occurring insomnia. Little research has been conducted to evaluate behavioral treatments for insomnia in youth with migraine.

We conducted a single-arm pilot trial to evaluate the feasibility and acceptability of delivering cognitive-behavioral therapy for insomnia to 21 youth (mean age 15.5, standard deviation 1.6) with co-occurring chronic migraine and insomnia. Adolescents completed up to 6 individual treatment sessions over 6 to 12 weeks, and 1 booster session 1 month later. Assessments included a prospective 7-day headache and sleep diary, and self-report measures of insomnia, sleep quality, sleep habits, and activity limitations at pre-treatment, immediate post-treatment, and 3-month follow-up.

Adolescents demonstrated good treatment adherence and families rated the intervention as highly acceptable. Preliminary analyses indicated improvements from pre-treatment to post-treatment in primary outcomes of headache days (M = 4.7, SD = 2.1 vs M = 2.8, SD = 2.7) and insomnia symptoms (M = 16.9, SD = 5.2 vs M = 9.5, SD = 6.2), which were maintained at 3-month follow-up (M = 2.7, SD = 2.8; M = 9.3, SD = 5.0, respectively). We also found improvements in secondary outcomes of pain-related activity limitations as well as sleep quality, sleep hygiene, and sleep patterns.

These preliminary data indicate that hybrid cognitive-behavioral therapy is feasible and acceptable for youth with co-occurring chronic migraine and insomnia. Future randomized controlled trials are needed to test treatment efficacy on migraine, sleep, and functional outcomes. Identifier: NCT03137147.

Of 21 patients, 17 adhered to treatment during the entire course of the study, and approximately 75% of participants completed the booster session. Both parents and adolescents reported that the therapy was highly acceptable (mean score of Treatment Evaluation Inventory, Short Form [TEI-SF] for parents=40.67±4.48; mean score of TEI-SF for adolescents=39.13±5.10). Self-reported headache frequency on the prospective 7-day diary was reduced from pretreatment to immediately after therapy (b =−1.91; P =.004; d =0.84), which was maintained at follow-up (b =−2.16; P =.002; d =0.87).

No changes were observed in headache pain intensity; however, from pretreatment to posttreatment (b =0.40; P =.25; d =−0.28) or at follow-up (b =−0.15; P =.68; d =−0.28). Additionally, self-reported insomnia symptoms were reduced from before and immediately after treatment (b =−7.32; P =.001; d =1.31). These findings were maintained at follow-up (b =−7.60; P =.001; d =0.50). Self-reported sleep efficiency also improved from pretreatment to posttreatment (b=9.31; P =.008; d=−0.60); these findings were maintained at 3-month follow-up (b =13.51; P =.001; d =−0.95).

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