Multimodal compared to pharmacologic treatments for chronic tension-type headache in adolescents.
Chronic tension-type headache (CTTH) in children and adolescents is a serious medical condition, with considerable morbidity and few effective, evidence-based treatments. We performed a chart review of 83 adolescents (age range = 13-18 years; 67 girls and 16 boys) diagnosed with CTTH. Two treatment protocols were compared: multimodal (osteopathic manipulative treatments, mindfulness, and qi gong) and pharmacologic (amitriptyline or gabapentin). Four outcomes (headache frequency, pain intensity, general health, and health interference) were assessed at three time points (baseline, 3 months, and 6 months). A fifth outcome, number of bilateral tender points, was recorded at baseline and 6 months. All five were evaluated statistically with a linear mixed model. Although both multimodal and pharmacologic treatments were effective for CTTH (time effects for all measures were significant at p < .001), results from each analysis favored multimodal treatment (the five group by time interaction effects were significant at or below the p < .001 level). Headache frequency in the pharmacologic group, for example, reduced from a monthly average (95% Confidence Interval shown in parentheses) of 23.9 (21.8, 26.0) to 16.4 (14.3, 18.6) and in the multimodal group from 22.3 (20.1, 24.5) to 4.9 (2.6, 7.2) (a substantial group difference). Pain intensity (worst in the last 24 hours, 0-10 scale) was reduced in the pharmacologic group from 6.2 (5.6, 6.9) to 3.4 (2.7, 4.1) and from 6.1 (5.4, 6.8) to 2.0 (1.2, 2.7) in the multimodal group (a less substantial difference). Across the other three assessments, group differences were larger for general health and number of tender points and less so for pain restriction. Multimodal treatment for adolescent CTTH appears to be effective. Randomized controlled trials are needed to confirm these promising results.
Betty Ford Center, Rancho Mirage, CA 92270, USA; Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA; Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA; Department of Psychiatry, Loma Linda University School of Medicine, Loma Linda CA 92350, USA. Electronic address: pprzekop@llu.edu.
Peter
P
Przekop
Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA; Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA.
Allison
A
Przekop
Department of Psychiatry, Loma Linda University School of Medicine, Loma Linda CA 92350, USA.
Mark G
MG
Haviland
D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D026301:Manipulation, Osteopathic / Q000379:methods*; D064866:Mindfulness / Q000379:methods*; D059352:Musculoskeletal Pain / Q000628:therapy; D010147:Pain Measurement; D064906:Qigong / Q000379:methods*; D018781:Tension-Type Headache / Q000628:therapy*
D018712:Analgesics, Non-Narcotic
Adolescent; Chronic tension-type headache; Mindfulness; Qi gong; Stress; Treatment