title: Pilot Randomized Controlled Trial of Internet-Delivered Cognitive-Behavioral Treatment for Pediatric Headache.
abstract: OBJECTIVE
  To evaluate the feasibility and preliminary effectiveness of an Internet-delivered cognitive-behavioral therapy (CBT) intervention for adolescents with chronic headache.
  
  
  BACKGROUND
  Headache is among the most common pain complaints of childhood. Cognitive-behavioral interventions are efficacious for improving pain among youth with headache. However, many youth do not receive psychological treatment for headache due to poor access, which has led to consideration of alternative delivery modalities such as the Internet.
  
  
  METHODS
  We used a parallel arm randomized controlled trial design to evaluate the feasibility and preliminary effectiveness of an Internet-delivered family-based CBT intervention, Web-based management of adolescent pain. Adolescents were eligible for the trial if they were a new patient being evaluated in a specialized headache clinic, between 11 and 17 years of age, and had recurrent headache for 3 months or more as diagnosed by a pediatric neurologist. Eighty-three youths were enrolled in the trial. An online random number generator was used to randomly assign participants to receive Internet CBT adjunctive to specialized headache treatment (n = 44) or specialized headache treatment alone (n = 39). The primary treatment outcome was headache days.
  
  
  RESULTS
  Youth and parents in the Internet CBT group demonstrated high levels of engagement with the web program and reported satisfaction with the intervention. Multilevel modelling (MLM) was used to conduct hypothesis testing for continuous outcomes. For our primary treatment outcome of headache days, adolescents reported a statistically significant reduction in headache days from baseline to post-treatment and baseline to 3-month follow-up in both treatment conditions (main effect for time F(2, 136) = 19.70, P < .001). However, there was no statistically significant difference between the Internet CBT group and the specialized headache treatment group at post-treatment or follow-up (group × time interaction F(2, 134) = 0.94, P = .395). For our secondary treatment outcomes, findings from MLM showed that adolescents in both groups demonstrated statistically significant improvement headache pain intensity, activity limitations, depressive symptoms, and parent protective behaviors from baseline to post-treatment and these gains were maintained at 3-month follow-up. Adolescent anxiety symptoms and sleep did not change during the study period for either group. There were no statistically significant group differences on any secondary outcomes at post-treatment or follow-up (P > .05 for all outcomes). No adverse events were reported.
  
  
  CONCLUSIONS
  Although adjunctive Internet CBT did not lead to additional benefit in this population, future research should evaluate whether it is an effective intervention for adolescents with headache who are unable to access specialized headache treatment.
authors: Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, USA.|Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA.
authors: Emily F
authors: EF
authors: Law
authors: Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA.
authors: Sarah E
authors: SE
authors: Beals-Erickson
authors: Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA.
authors: Melanie
authors: M
authors: Noel
authors: Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School and Boston Children's Hospital, Boston, USA.
authors: Robyn
authors: R
authors: Claar
authors: Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, USA.|Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, USA.
authors: Tonya M
authors: TM
authors: Palermo
mesh_terms: D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D008297:Male; D059408:Pain Management / Q000379:methods* / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods / Q000523:psychology; D010865:Pilot Projects; D016896:Treatment Outcome
keywords: headache, children, adolescents, pediatric, cognitive-behavioral therapy, Internet intervention, randomized controlled trial