title: Cognitive behavioural treatment for the chronic post-traumatic headache patient: a randomized controlled trial.
abstract: BACKGROUND
  Chronic post-traumatic headache (CPTH) after mild head injury can be difficult to manage. Research is scarce and successful interventions are lacking.To evaluate the effect of a group-based Cognitive Behavioural Therapy (CBT) intervention in relation to headache, pain perception, psychological symptoms and quality of life in patients with CPTH.
  
  
  METHODS
  Ninety patients with CPTH according to ICHD-2 criteria were enrolled from the Danish Headache Center into a randomized, controlled trial. Patients were randomly assigned to either a waiting list group or to a nine-week CBT group intervention. At baseline and after 26 weeks all patients completed the Rivermead Post Concussion Symptoms Questionnaire, SF-36, SCL-90-R and a headache diary.
  
  
  RESULTS
  The CBT had no effect on headache and pressure pain thresholds and only a minor impact on the CPTH patients' quality of life, psychological distress, and the overall experience of symptoms. The waiting-list group experienced no change in headache but, opposed to the treatment group, a significant decrease in somatic and cognitive symptoms indicating a spontaneous remission over time.
  
  
  CONCLUSIONS
  Our primarily negative findings confirm that management of patients with CPTH still remains a considerable challenge. Psychological group therapy with CBT might be effective in an earlier stage of CPTH and in less severely affected patients but our findings strongly underline the need for randomized controlled studies to test the efficacy of psychological therapy.
authors.forename: Dorte
authors.initials: D
authors.lastname: Kjeldgaard
authors.forename: Hysse B
authors.initials: HB
authors.lastname: Forchhammer
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Teasdale
authors.affiliation: Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 69, DK-2600 Glostrup, Copenhagen, DK, Denmark. rigmor.jensen@regionh.dk.
authors.forename: Rigmor H
authors.initials: RH
authors.lastname: Jensen
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058748:Pain Perception; D051298:Post-Traumatic Headache / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life / Q000523:psychology*; D012075:Remission, Spontaneous; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult