Pediatric Migraine: Cognitive Behavioral Therapy

The use of cognitive behavioral therapy (CBT) to treat migraine headaches in children and adolescents may be significantly beneficial, according to the results of a meta-analysis published recently in Headache.

“Given that children often continue to struggle with migraine into adulthood and its incapacitating effects on a child’s life, an effective management strategy for pediatric migraine is imperative,” wrote Qin Xiang Ng, MBBS, National University of Singapore, and colleagues. “There is good evidence that CBT is viable in the management of pediatric migraine, and it should thus be routinely offered as a first-line treatment and not only as an add-on if medications prove ineffective.”

CBT is an evidence-based practice that helps patients to develop coping strategies and cognitive restructuring to alter the pain experience. In children and adolescents there are five main components: psychoeducation, self-monitoring, coping skills training, relapse prevention, and homework. Although the efficacy of CBT in adults is well-documented, no meta-analysis on its use in children and adolescents existed.

Here, Ng and colleagues reviewed the results of 14 studies of CBT for headache and migraine conducted from 1980 to 2016. For the meta-analysis, they defined a clinically significant improvement as 50% or greater headache activity reduction post-treatment and at follow-up of 3 months or later. The pooled odds ratio (OR) of improvements was 9.11 for headache reduction post-treatment and 9.18 at follow-up.

According to the researchers, this demonstrated a significantly clinical improvement compared with wait-list control, placebo, or standard medication. In addition, the improvement seen was persistent, evident even at 1-year follow-up in certain included studies.

“The conclusions of this review cohere with an earlier Cochrane review done in 2014, which studied the efficacy of broad psychological therapies (including relaxation, coping skills training, hypnosis, biofeedback, and CBT) for the management of chronic and recurrent pain in children and adolescents,” the researchers wrote. “The review found that psychological therapies have a significant and lasting effect in reducing pain and disability for chronic headache conditions.”

The researchers noted that the use of CBT in a pediatric setting does have some pitfalls, including that it is time-intensive and can be costly.

Reference: Ng QX, et al. A systematic review and meta-analysis of the efficacy of cognitive behavioral therapy for the management of pediatric migraine. Headache. Epub 2016 Dec 28.