One‐Day Behavioral Intervention in Depressed Migraine Patients: Effects on Headache

Abstract

Objective To determine whether a 1-day behavioral intervention, aimed at enhancing psychological flexibility, improves headache outcomes of migraine patients with comorbid depression. Background Migraine is often comorbid with depression, with each disorder increasing the risk for onset and exacerbation of the other. Managing psychological triggers, such as stress and depression, may result in greater success of headache management. Method Sixty patients with comorbid migraine and depression were assigned to a 1-day Acceptance and Commitment Training plus Migraine Education workshop (ACT-ED; N=38) or to Treatment as Usual (TAU; N=22). Patients completed a daily headache diary prior to, and for 3 months following, the intervention. Clinical variables examined included headache frequency/severity, medication use, disability, and visit to a healthcare professional. Comparisons were made between baseline findings and findings at the 3-month follow-up. Results Participants assigned to the ACT-ED condition exhibited significant improvements in headache frequency, headache severity, medication use, and headache-related disability. In contrast, the TAU group did not exhibit improvements. The difference in headache outcomes between ACT-ED and TAU was not statistically significant over time (i.e., the treatment by time interaction was non-significant). These results complement those of a previous report showing effects of ACT-ED verus TAU on depression and disability (1). Conclusion A 1-day ACT-ED workshop targeting psychological flexibility may convey benefit for patients with comorbid migraine and depression. These pilot study findings merit further investigation using a more rigorously designed large-scale trial.

Cognitive behavior therapy for comorbid migraine and/or tension-type headache and major depressive disorder: An exploratory randomized controlled trial

“…The effects for depression were larger than for headaches, consistent with the trial by Dindo and colleagues (Dindo et al, 2014(Dindo et al, , 2012. The mean BDI-II score of the treatment group at baseline of 30.6 falls in the 'severe depression' category, and the mean score at post-treatment of 13.1 falls in the 'minimal to mild depression' category and below the cut-off for 'may need treatment' of 17.…”

“…The latter finding is unique as the only previous trial of an integrated treatment for comorbid headaches and depression failed to find a significant difference between headache changes in the treatment and control groups (Dindo et al, 2014). The reason for the different findings between the studies is not clear but the two studies did use quite different behavioral interventions as the intervention in Dindo et al was a one-day Acceptance and Commitment Training plus Migraine Education workshop, as distinct from the 12 weekly 50-min sessions of CBT based on a functional model used in this study.…”

“…The study compared the intervention with 'wait list/treatment as usual' and reported that participants who received the intervention exhibited significant improvements in headache frequency, headache severity, medication use and headache-related disability at three month follow-up. The control group did not show improvement over time, but the difference in outcomes between the two groups was not statistically significant (Dindo et al, 2014). Participants in the intervention group exhibited significantly greater improvements in depressive symptoms than participants in the control group (Dindo et al, 2012).…”

“…A recent study did evaluate a one-day behavioral intervention based on Acceptance and Commitment Training plus Migraine Education for depressed migraine patients (Dindo, Recober, Marchman, O'Hara, & Turvey, 2014;Dindo, Recober, Marchman, Turvey, & O'Hara, 2012). The study compared the intervention with 'wait list/treatment as usual' and reported that participants who received the intervention exhibited significant improvements in headache frequency, headache severity, medication use and headache-related disability at three month follow-up.…”

Psychological Interventions for the Management of Chronic Pain: a Review of Current Evidence

“…There were no significant differences in treatment outcomes between groups. In another study, researchers assigned patients with comorbid migraine and depression to either a 1-day ACT training plus migraine education workshop or to treatment as usual [17]. The results suggested that participants in the experimental condition demonstrated significant improvements in reducing headache frequency, headache severity, medication use, and headacherelated disability, while the control group did not demonstrate improvements in these outcomes.…”