title: Trajectory of Improvement in Children and Adolescents With Chronic Migraine: Results From the Cognitive-Behavioral Therapy and Amitriptyline Trial.
abstract: We compared headache frequency trajectories between clinical trial participants who received cognitive-behavioral therapy (CBT) and amitriptyline (CBT+A) or headache education (HE) and amitriptyline (HE+A) to determine if there was a differential time course of treatment response between the groups. One hundred thirty-five patients (age 10-17 years) diagnosed with chronic migraine participated, attending 8 one-hour one-on-one CBT or HE sessions with a trained psychologist for 8 weekly sessions, 2 sessions at weeks 12 and 16, and a post-treatment visit at week 20. Participants kept daily headache diaries and completed take-home assignments between visits. Data from daily headache diaries are presented for each day and according to 28-day periods. Trajectories of improvement indicate initial decrease in headache days began during the first month of treatment, for both groups, and continued to decrease throughout treatment. The CBT+A group had greater daily improvement than the HE+A group. A significantly greater proportion of the CBT+A group had a ≥50% reduction in headache days each month, and a significantly greater proportion of the CBT+A group had ≤4 headache days per month in months 3 through 5. Results indicate the trajectory of decrease in headache days is significantly better for patients receiving CBT+A versus HE+A.
  
  
  
  This article presents daily information about headache frequency over a 20-week clinical trial. Youth with chronic migraine who received CBT+A improved faster than those in the control group. Findings provide clinicians with evidence-based expectations for treatment response over time and ways of monitoring treatment success.
  
  
  
  clinicaltrials.gov identifier NCT00389038.
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: John W
authors.initials: JW
authors.lastname: Kroner
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: James
authors.initials: J
authors.lastname: Peugh
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Susmita M
authors.initials: SM
authors.lastname: Kashikar-Zuck
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Susan L
authors.initials: SL
authors.lastname: LeCates
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Janelle R
authors.initials: JR
authors.lastname: Allen
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Shalonda K
authors.initials: SK
authors.lastname: Slater
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Marium
authors.initials: M
authors.lastname: Zafar
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Marielle A
authors.initials: MA
authors.lastname: Kabbouche
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Hope L
authors.initials: HL
authors.lastname: O'Brien
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Chad E
authors.initials: CE
authors.lastname: Shenk
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Kroon Van Diest
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Hershey
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: Scott.Powers@cchmc.org.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Powers
mesh_terms: D000293:Adolescent; D000639:Amitriptyline / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D002648:Child; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008499:Medical Records; D008881:Migraine Disorders / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000639:Amitriptyline
keywords: Pain; clinical trial; headache; pediatrics; treatment