Effectiveness of Cognitive Behavioral Therapy for Pediatric Migraine
by Lauren Doyle Strauss, DO
Cognitive behavioral therapy (CBT) is an evidence-based practice that focuses on helping patients develop coping strategies, change harmful thought patterns, and learn how to improve their experience with illness. In children and adolescents, it was first developed to treat depression; and it is now used to treat anxiety disorders, body dysmorphic disorder, eating disorders and obesity, obsessive compulsive disorder, and posttraumatic stress disorder. Several groups have explored the effectiveness of CBT in children and adolescents for the management of headaches.
More recently in 2013, researcher Dr. Scott Powers and others from Cincinnati Children’s Hospital published in the Journal of American Medical Association studying CBT in pediatric migraine. All the patients studied were treated amitriptyline; however, the addition of CBT resulted in significantly greater reductions in both headache frequency and migraine-related disability when compared to another intervention of headache education course. This improvement was still seen in patients who had received CBT at their follow ups at 12 or 20 weeks later.
A Cochrane Review in 2014 studied the efficacy of broad psychological therapies which included CBT, but also looked at relaxation, coping skills training, hypnosis, biofeedback for the management of chronic and recurrent pain in children and adolescents. The review showed psychological therapies have a significant and lasting effect in reducing pain and disability for chronic headache.
This month, Dr. Qin Xiang Zin from the Yong Loo Lin School of Medicine in Singapore published in Headache a systematic review and meta-analysis on the effectiveness of CBT in pediatric migraine where 3841 articles were selected for review and ultimately 14 were included in the analysis. The results of the meta-analysis well-support the use of CBT in the management of pediatric migraine when looking at whether there is a 50% or greater headache activity reduction post-treatment at follow-up (3 months or later).