Background
Educational control | Headstrong | ||||
---|---|---|---|---|---|
(n = 17) | (n = 18) | p | |||
Demographics | |||||
Age (yrs, M, SD) | 10.2 | 1.5 | 10.2 | 2.0 | 0.91 |
Gender (female, n,%) | 15 | 88% | 10 | 56% | 0.06 |
Ethnicity (Caucasian, n,%) | 16 | 94% | 17 | 94% | 1.00 |
Grade in school (M, SD) | 4.6 | 1.6 | 4.4 | 2.1 | 0.91 |
CBCL total score (M, SD) | 52.0 | 7.8 | 49.9 | 11.0 | 0.60 |
Mother's age (yrs, M, SD) | 35.7 | 6.2 | 37.9 | 8.1 | 0.50 |
Father's age (yrs, M, SD) | 37.9 | 5.8 | 41.8 | 8.1 | 0.17 |
Mother's ed (some college, n,%) | 11 | 65% | 13 | 76% | 0.71 |
Father's ed (some college, n,%) | 11 69% | 12 | 67% | 1.00 | |
Family income (>$50,000, n,%) | 10 | 59% | 15 | 83% | 0.15 |
Headache parameters | |||||
Migraine diagnosis (n,%) | 17 | 100% | 16 | 89% | 0.49 |
Ibuprofen prescribed (n,%) | 8 | 47% | 12 | 67% | 0.32 |
Nortriptyline prescribed (n,%) | 2 | 12% | 4 | 22% | 0.658 |
Method
Participants
Phase | Baseline | Intervention | Post-intervention | 3-months post-intervention | |||
---|---|---|---|---|---|---|---|
Study week: | 1 | 2 | 3 to 6 | 7 | 8 | 19 | 20 |
Child behavior checklist and demographics | • | No measures taken | |||||
Daily headache diary | • | • | • | • | • | • | |
PedsQL 4.0 | • | • | • | ||||
PedMIDAS | • | • | • |
Research design
Control group
Headstrong group
Procedures
Child behavior checklist and demographics
Headache diaries
Headache-related disability
Quality of life (QOL)
Statistical analyses
Results
Participants
Educational control lessons | Headstrong lessons | |
---|---|---|
Week 1 |
Headache education
|
Headache education & cognitive-behavioral model of pain
|
1). Introduction | 1). Introduction | |
2). Types of headache | 2). Types of headache | |
3). Prevalence of headache | 3). Prevalence of headache | |
4). Features of headache | 4). Features of headache | |
5). How headache is diagnosed | 5). How headache is diagnosed | |
6). The pain puzzle | ||
7). Headache triggers | ||
Week 2 |
Cognitive-behavioral model of pain
|
Relaxation
|
1). Introduction to the pain puzzle | 1). Rationale for relaxation | |
2). puzzle piece 1: Nociception | 2). How to use guided imagery | |
3). Puzzle piece 2: Thoughts | 3). How to use deep breathing | |
4). How to use progressive muscle relaxation | ||
Week 3 |
Cognitive-behavioral model of pain
|
Cognitive restructuring
|
1). Puzzle piece 3: Feelings | 1). Rationale for coping | |
2). Puzzle piece 4: Behavior | 2). Thought-changing | |
3). Problem-solving | ||
Week 4 |
Headache triggers
|
Pain behaviors
|
1). Introduction to headache triggers | 1). Positive and negative pain behaviors | |
2). Key headache triggers: diet and sleep | 2). Importance of keeping active | |
3). Review of all lessons |
Child reported outcomes
Baseline | Post-intervention | 3-Months post-intervention | |||||
---|---|---|---|---|---|---|---|
TX | CTRL | TX | CTRL | TX | CTRL | ||
n | 18.. . | 17. . . | 18. . . | 17. . . | 11. . . | 11. . . | |
Headache frequency (% of days)
| Mean | 41.09 | 40.67 | 31.28 | 32.14 | 21.43 | 18.18 |
Median | 35.71 | 35.71 | 25.00 | 28.57 | 7.14 | 14.29 | |
SD | 22.67 | 28.79 | 28.24 | 22.23 | 23.47 | 17.60 | |
p | 0.48 | 0.46 | 0.36 | ||||
ES | 0.0 | 0.0 | 0.2 | ||||
Headache duration (hr/episode)
| Mean | 5.47 | 4.15 | 4.47 | 5.56 | 1.53 | 4.25 |
Median | 4.04 | 2.86 | 3.71 | 4.25 | 1.50 | 2.65 | |
SD | 4.20 | 3.88 | 4.26 | 4.01 | 0.91 | 5.19 | |
p | 0.19 | 0.24 | 0.07 | ||||
ES | 0.3 | 0.3 | 0.7 | ||||
Headache severity (10-point VAS)
| Mean | 5.06 | 6.00 | 5.06 | 6.25 | 4.46 | 3.68 |
Median | 4.61 | 5.90 | 5.42 | 6.06 | 4.33 | 3.75 | |
SD | 1.84 | 1.52 | 1.50 | 1.92 | 1.88 | 2.04 | |
p | 0.07 | 0.03* | 0.20 | ||||
ES | 0.6 | 0.7 | 0.4 | ||||
PedMIDAS total (0 to >50)
| Mean | 13.26 | 15.53 | 7.82 | 12.29 | 0.91 | 3.50 |
Median | 14.00 | 12.00 | 3.00 | 7.00 | 0.00 | 2.00 | |
SD
| 9.69 | 10.08 | 10.59 | 12.94 | 1.45 | 4.86 | |
p | 0.25 | 0.14 | 0.05 | ||||
ES | 0.2 | 0.4 | 0.7 | ||||
PedsQL total (0 to 100)
| Mean | 82.10 | 79.35 | 83.70 | 80.69 | 84.88 | 85.67 |
Median | 82.61 | 83.70 | 85.87 | 84.78 | 93.48 | 89.13 | |
SD
| 12.18 | 11.55 | 12.07 | 14.36 | 18.22 | 14.32 | |
p | 0.25 | 0.26 | 0.46 | ||||
ES | 0.2 | 0.2 | 0.0 |
Parent reported outcomes
Baseline | Post-intervention | 3-Months post-intervention | |||||
---|---|---|---|---|---|---|---|
TX | CTRL | TX | CTRL | TX | CTRL | ||
n | 18… | 17… | 18… | 17… | 11… | 11… | |
Headache frequency (% of days)
| Mean | 39.29 | 38.66 | 30.93 | 30.25 | 19.48 | 16.88 |
Median | 35.71 | 35.71 | 25.00 | 28.57 | 7.14 | 14.29 | |
SD
| 22.35 | 28.80 | 28.74 | 21.51 | 22.61 | 17.58 | |
p | 0.47 | 0.47 | 0.38 | ||||
ES | 0.0 | 0.0 | 0.1 | ||||
Headache duration (hr/episode)
| Mean | 5.69 | 3.72 | 5.63 | 5.25 | 1.76 | 3.94 |
Median | 3.65 | 2.46 | 4.29 | 4.19 | 1.50 | 4.25 | |
SD
| 4.58 | 3.49 | 4.17 | 3.58 | 1.23 | 3.95 | |
p | 0.10 | 0.40 | 0.08 | ||||
ES | 0.5 | 0.1 | 0.8 | ||||
Headache severity (10-point VAS)
| Mean | 6.37 | 6.52 | 6.15 | 6.84 | 4.57 | 5.63 |
Median | 6.46 | 6.77 | 6.25 | 7.19 | 4.75 | 5.00 | |
SD
| 2.01 | 1.92 | 1.56 | 1.37 | 1.98 | 2.30 | |
p | 0.42 | 0.10 | 0.17 | ||||
ES | 0.0 | 0.5 | 0.5 | ||||
PedMIDAS total
| Mean | 14.94 | 14.21 | 9.06 | 10.50 | 1.36 | 5.18 |
(0 to >50)
| Median | 15.00 | 12.50 | 4.00 | 6.00 | 0.00 | 2.00 |
SD
| 10.63 | 8.41 | 11.82 | 11.24 | 2.06 | 6.40 | |
p | 0.41 | 0.36 | 0.04 | ||||
ES | 0.1 | 0.1 | 0.8 | ||||
PedsQL total
| Mean | 78.07 | 80.95 | 81.01 | 81.84 | 88.74 | 88.73 |
(0 to 100)
| Median | 77.17 | 79.35 | 82.61 | 84.78 | 93.48 | 91.30 |
SD
| 14.17 | 9.81 | 12.36 | 15.95 | 11.28 | 7.75 | |
p | 0.25 | 0.43 | 0.50 | ||||
ES | 0.2 | 0.1 | 0.0 |