title: Medium-term effectiveness of online behavioral training in migraine self-management: A randomized trial controlled over 10 months.
abstract: OBJECTIVE
  This randomized, controlled trial examined the medium-term effectiveness of online behavioral training in migraine self-management (oBT; N = 195) versus waitlist control (WLC; N = 173) on attack frequency, indicators of self-management (primary outcomes), headache top intensity, use of rescue medications, quality of life and disability (secondary outcomes).
  
  
  METHODS
  An online headache diary following the ICHD-II and questionnaires were completed at baseline (T0), post-training (T1) and six months later (T2). Missing data (T1: 24%; T2: 37%) were handled by multiple imputation. We established effect sizes (ES) and tested between-group differences over time with linear mixed modelling techniques based on the intention-to-treat principle.
  
  
  RESULTS
  At T2, attack frequency had improved significantly in oBT (-23%, ES = 0.66) but also in WLC (-19%; ES = 0.52). Self-efficacy, internal and external control in migraine management--and triptan use--improved only in oBT, however. This indicates different processes in both groups and could signify (the start of) active self-management in oBT. Also, only oBT improved migraine-specific quality of life to a sizable extent.
  
  
  CONCLUSIONS
  oBT produced self-management gains but could not account for improved attack frequency, because WLC improved as well. The perspective that BT effects develop gradually, and that online delivery will boost BT outreach, justifies further research.
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, the Netherlands m.j.sorbi@uu.nl.
authors.forename: M J
authors.initials: MJ
authors.lastname: Sorbi
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, the Netherlands Department of Clinical Psychology, VU University, the Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Kleiboer
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, the Netherlands.
authors.forename: H G
authors.initials: HG
authors.lastname: van Silfhout
authors.affiliation: Department of Methodology and Statistics, Utrecht University, the Netherlands Department of Quality and Methodology, Statistics Netherlands, the Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Vink
authors.affiliation: Department of Clinical Psychology, VU University, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Passchier
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods / Q000639:trends*; D019468:Disease Management; D005260:Female; D006801:Humans; D020407:Internet / Q000639:trends*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011446:Prospective Studies; D012648:Self Care / Q000379:methods / Q000523:psychology / Q000639:trends*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Internet intervention; Migraine self-management; behavioral training; longer-term follow-up; online headache diary