title: A randomized controlled trial of an internet-based treatment for chronic headache.
abstract: Chronic headache is a significant public health problem in Western nations. Although controlled trials demonstrate the efficacy and cost-effectiveness of face-to-face behavioral therapy, most headache sufferers have limited access to these treatments. Delivery of behavioral interventions using Internet technology has the potential to reach a larger number of headache sufferers and reduce the burden of disease. This randomized controlled study evaluated an Internet-delivered behavioral regimen composed of progressive relaxation, limited biofeedback with autogenic training, and stress management versus a symptom monitoring waitlist control. Treatment led to a significantly greater decrease in headache activity than symptom monitoring alone. Thirty-nine percent of treated individuals showed clinically significant improvement on self-report measures of headache symptoms at post-treatment. At two-month follow-up, 47% of participants maintained improvement. Treatment had a significant impact on general headache symptoms and headache-related disability. There was a 35% within-group reduction of medication usage among the treated subjects. The Internet program was more time-efficient than traditional clinical treatment. Treatment and follow-up dropout rates, 38.1% and 64.8%, respectively, were typical of behavioral self-help studies. This approach to self-management of headache is promising; however, several methodological and ethical challenges need to be addressed.
authors.affiliation: Conemaugh Health System, 122 Montour Street, Johnstown, PA 15905 2422, USA. tdevinen@conemaugh.org
authors.forename: Trishul
authors.initials: T
authors.lastname: Devineni
authors.forename: Edward B
authors.initials: EB
authors.lastname: Blanchard
mesh_terms: D000328:Adult; D001326:Autogenic Training / Q000191:economics / Q000379:methods; D001521:Behavior Therapy / Q000191:economics / Q000379:methods; D001676:Biofeedback, Psychology; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D020773:Headache Disorders / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D020407:Internet; D008297:Male; D008881:Migraine Disorders / Q000188:drug therapy / Q000628:therapy; D010352:Patient Dropouts; D012064:Relaxation Therapy / Q000191:economics; D013315:Stress, Psychological / Q000628:therapy; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D018781:Tension-Type Headache / Q000188:drug therapy / Q000628:therapy; D016896:Treatment Outcome