title: Behavioral management of the triggers of recurrent headache: a randomized controlled trial.
abstract: This study was designed to evaluate the traditional advice to headache sufferers to avoid all triggers ('Avoidance'), and a novel approach to trigger management (Learning to Cope with Triggers - 'LCT') that included graduated exposure to selected triggers to promote desensitization. Individuals (84F, 43M) with migraine and/or tension-type headache were assigned randomly to one of four groups: Waiting-list (Waitlist); Avoidance; Avoidance combined with cognitive behavior therapy (Avoid + CBT); and LCT. Changes in headaches and medication consumption (in parentheses) from pre- to post-treatment were (a minus sign indicates improvement): Waitlist, +11.0% (+15.4%); Avoidance, -13.2% (-9.0%); Avoid + CBT, -30.0% (-19.4%); and LCT, -35.9% (-27.9%). Avoidance did not differ significantly from Waitlist on headaches or medication use, but LCT differed significantly from Waitlist on both measures. Avoid + CBT significantly differed from Waitlist on headaches but not medication consumption. In summary, the study failed to find support for the standard approach to trigger management of advising avoidance, but LCT emerged as a promising strategy. LCT resulted in greater improvement than the other three conditions on all measures of headaches and medication consumption, and was the only treatment condition that significantly differed from the waiting-list control condition in terms of treatment responder rate (50% or greater reduction in headaches) and medication consumption.
authors.affiliation: School of Applied Psychology, Behavioural Basis of Health Research Centre, Griffith University, Mt Gravatt Campus, 176 Messines Ridge Road, Mt Gravatt, Queensland 4122, Australia. Electronic address: paul.martin@griffith.edu.au.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Martin
authors.affiliation: School of Health Sciences, RMIT University, PO Box 71, Bundoora, Victoria 3083, Australia; Australian College of Applied Psychology, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Reece
authors.affiliation: School of Psychology and Psychiatry, Monash University, Monash Medical Centre, 246 Clayton Road, Victoria 3168, Australia.
authors.forename: Moira
authors.initials: M
authors.lastname: Callan
authors.affiliation: School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
authors.forename: Colin
authors.initials: C
authors.lastname: MacLeod
authors.affiliation: School of Psychology and Psychiatry, Monash University, Monash Medical Centre, 246 Clayton Road, Victoria 3168, Australia.
authors.forename: Archana
authors.initials: A
authors.lastname: Kaur
authors.affiliation: School of Psychology and Psychiatry, Monash University, Monash Medical Centre, 246 Clayton Road, Victoria 3168, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Gregg
authors.affiliation: Headache Group, NIHR-Welcome Trust Clinical Research Facility, King's College London, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goadsby
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D015928:Cognitive Behavioral Therapy; D003463:Cues; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000523:psychology / Q000628:therapy*; D020377:Self Efficacy; D018781:Tension-Type Headache / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Coping; Desensitization; Migraine; Tension-type headache; Triggers