Cognitive-Behavioral Group Treatment for Disabling Headache

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Abstract
Objectives Severe, disabling headache is costly to individual sufferers, through pain and reduced functioning, and to society, through decreased work productivity and increased health care use. First-line prophylactic agents combined with triptans do not adequately benefit many disabled headache sufferers. We sought to investigate whether a cognitive-behavioral treatment targeting the psychological and behavioral factors that contribute to disabling headache may provide additional benefit and whether using a group format may provide a more intensive clinic-based treatment without increasing the cost of service delivery. Design We developed and piloted a cognitive-behavioral group treatment for chronic, disabling headache. We evaluated its effectiveness in decreasing headache, reducing symptomatic medication use, and improving quality of life. Setting A behavioral headache management program of an academic medical center. Patients Sixty-two individuals suffering from primary headache disorder with moderate to severe headache-related disability who completed treatment. Interventions Individuals completed a pretreatment evaluation, the 10-session cognitive-behavioral group treatment, and a 1-month-posttreatment evaluation. Outcome Measures The impacts of treatment on headache (frequency, intensity, and duration), medication use, and quality of life were assessed. Results Separate multivariate analyses of variance revealed significant improvements in headache, symptomatic medication use, and quality of life. Overall, 50% of participants experienced at least a 50% reduction in headache frequency from pre- to posttreatment. Conclusions The findings provide preliminary evidence that delivering a clinic-based, group-format cognitive-behavioral treatment to moderately to severely disabled headache sufferers can decrease headache activity, reduce symptomatic medication use, and improve quality of life.