title: Treatment Adherence in Child and Adolescent Chronic Migraine Patients: Results From the Cognitive-Behavioral Therapy and Amitriptyline Trial.
abstract: OBJECTIVE
  To examine treatment adherence among children and adolescents with chronic migraine who volunteered to be in a clinical trial using 3 measures: treatment session attendance, therapy homework completion, and preventive medication use by daily diary.
  
  
  METHODS
  Analyses are secondary from a trial of 135 youth aged 10 to 17 years diagnosed with chronic migraine and with a Pediatric Migraine Disability Score over 20. Participants were randomly assigned to cognitive-behavioral therapy plus amitriptyline (CBT+A, N=64) or headache education plus amitriptyline (HE+A, N=71). Therapists recorded session attendance. Completion of homework/practice between sessions was reported to therapists by patients. Patients reported preventive medication adherence using a daily headache diary.
  
  
  RESULTS
  Mean session attendance adherence out of 10 treatment sessions was 95% for CBT+A and 99% for HE+A. CBT+A participants reported completing a mean of 90% of home practice of CBT skills between the 10 sessions. Participants reported taking amitriptyline daily at a mean level of 90% when missing diaries were excluded and 79% when missing diaries were considered as missed doses of medication.
  
  
  CONCLUSIONS
  Our findings demonstrate that youth with chronic migraine who agree to be a part of a clinical trial do quite well at attending therapy sessions, and report that they are adherent to completing home/practice between sessions and taking medication. These results lend further support to consideration of CBT+A as a first-line treatment for youth with chronic migraine and suggest that measurement of adherence when this treatment is provided in practice will be important.
authors.affiliation: Divisions of *Behavioral Medicine and Clinical Psychology §Neurology ‡Headache Center, Cincinnati Children's Hospital Medical Center †Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Kroon Van Diest
authors.forename: Rachelle R
authors.initials: RR
authors.lastname: Ramsey
authors.forename: Susmita
authors.initials: S
authors.lastname: Kashikar-Zuck
authors.forename: Shalonda
authors.initials: S
authors.lastname: Slater
authors.forename: Kevin
authors.initials: K
authors.lastname: Hommel
authors.forename: John W
authors.initials: JW
authors.lastname: Kroner
authors.forename: Susan
authors.initials: S
authors.lastname: LeCates
authors.forename: Marielle A
authors.initials: MA
authors.lastname: Kabbouche
authors.forename: Hope L
authors.initials: HL
authors.lastname: O'Brien
authors.forename: Joanne
authors.initials: J
authors.lastname: Kacperski
authors.forename: Janelle R
authors.initials: JR
authors.lastname: Allen
authors.forename: James
authors.initials: J
authors.lastname: Peugh
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Hershey
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; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D006261:Headache / Q000628:therapy; D006801:Humans; D008297:Male; D008499:Medical Records; D008881:Migraine Disorders / Q000628:therapy*; D000074822:Treatment Adherence and Compliance
chemical_list: D018712:Analgesics, Non-Narcotic; D000639:Amitriptyline