title: Enhancing cognitive-behavioural therapy for recurrent headache: design of a randomised controlled trial.
abstract: BACKGROUND
  We have argued against the traditional approach of counselling avoidance of all triggers of headaches and migraine. Problems with this approach include the impossibility of avoiding all triggers and the high costs associated with trying to do so, and that avoidance could lead to reduced tolerance for the triggers. We have developed an alternative approach called Learning to Cope with Triggers (LCT) that encourages avoidance of triggers that are detrimental to health and wellbeing, but uses exposure to other triggers to desensitise headache sufferers to the triggers. This approach has been shown to be more effective than advising avoidance of all triggers. Trigger management is only one component of a comprehensive treatment program and the current study is designed to evaluate a new approach to treating headaches in which LCT has been integrated into an established cognitive-behavioural therapy (CBT) package (LCT/CBT).
  
  
  METHODS
  A target sample of 120 adult participants who suffer from migraine or tension-type headache, at least six days per month, and have done so for at least 12 months will be recruited. Participants will be randomly assigned to one of three groups: LCT/CBT; Avoid/CBT (CBT combined with instructions to avoid all triggers); and waiting-list control. Measures will include: daily diaries for recording headaches, triggers and medication consumption; headache disability and quality of life; trigger avoidance; locus of control and self-efficacy; and coping strategies. Treatment will involve 12 60-minute sessions scheduled weekly. Assessment will be completed before and after treatment, and at 4 and 12 month follow-up. The data will be analysed to determine which approach is most effective, and predictors of response to treatment.
  
  
  CONCLUSIONS
  Migraine and tension-type headache are common and can be disabling. CBT has been demonstrated to be an efficacious treatment for both disorders. However, there is room for improvement. This study aims to increase the efficacy of behavioural approaches and identify factors predictive of a positive response.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ACTRN12614000435684 .
authors.affiliation: School of Applied Psychology and Behavioural Basis of Health, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia. paul.martin@griffith.edu.au.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Martin
authors.affiliation: School of Applied Psychology and Behavioural Basis of Health, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia. s.mackenzie@griffith.edu.au.
authors.forename: Sharon
authors.initials: S
authors.lastname: Mackenzie
authors.affiliation: School of Applied Psychology and Behavioural Basis of Health, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia. s.bandarian-balooch@griffith.edu.au.
authors.forename: Siavash
authors.initials: S
authors.lastname: Bandarian-Balooch
authors.affiliation: School of Applied Psychology and Behavioural Basis of Health, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia. a.brunelli@griffith.edu.au.
authors.forename: Arissa
authors.initials: A
authors.lastname: Brunelli
authors.affiliation: School of Medicine, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia. simon.broadley@griffith.edu.au.
authors.forename: Simon
authors.initials: S
authors.lastname: Broadley
authors.affiliation: School of Health Sciences, RMIT University, PO Box 71, Bundoora, Victoria, 3083, Australia. john.reece@acap.edu.au.|Australian College of Applied Psychology, Melbourne, Australia. john.reece@acap.edu.au.
authors.forename: John
authors.initials: J
authors.lastname: Reece
authors.affiliation: Headache Group, NIHR-Welcome Trust Clinical Research Facility, King's College London, London, UK. peter.goadsby@kcl.ac.uk.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goadsby
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D008881:Migraine Disorders / Q000628:therapy*; D011788:Quality of Life; D012107:Research Design; D018781:Tension-Type Headache / Q000628:therapy*