Background
A.
| Headache, no typical characteristics known, fulfilling criteria C and D |
B.
| Head trauma with all the following: |
1. either no loss of consciousness, or loss of consciousness of <30 minutes’ duration | |
2. Glasgow Coma Scale (GCS) ≥13 | |
3. symptoms and/or signs diagnostic of concussion | |
C.
| Headache develops within 7 days after head trauma |
D.
| Headache persists for >3 months after head trauma |
Methods
Participants
Interventions
Session | |
---|---|
1 | Introduction to the group and the diagnosis CPTH and it’s possible origins. |
2 | Introduction to the cognitive model and the stress-pain connection, identify stressors, and goal setting. |
3 | What is concentration? Memory problems and their possible origin when having headache. Relaxation technique: breathing exercise. |
4 | Memory and reading strategies. Management of energy. Relaxation technique: Progressive muscle relaxation. |
5 | Pain model. Acceptance and behaviour towards headache. Relaxation technique: short breathing exercise with body scan. |
6 | Acceptance of present headache state. Management of energy. Relaxation technique: visualisation of pleasant place. |
7 | Define and identify Negative Automatic Thoughts (NAT) Relaxation technique: visualisation mental preparation. |
8 | Examine NAT, develop alternative more adaptive thoughts. Relaxation technique: visualisation problem solving. |
9 | Integration and maintenance of new techniques and concepts. |
Outcomes
Headache assessment
Pressure pain thresholds
Health-related quality of life
Concussion symptoms
Psychological distress
Outcome measures
Sample size and effect size
Randomisation
Statistical methods
Results
Headache
Group A (N = 34) | Group B (N = 33-37*) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Assessment II
|
Assessment IV
|
Assessment II
|
Assessment IV
| p†† | |||||||
d † | d † | ||||||||||
Frequency (days/ 4 weeks) | 26.4 | (4.39) | 26.0 | (5.13) | .067 | 25.9 | (4.87) | 25.1 | (6.51) | .144 | .551 |
Intensity (0–10 scale) | 6.33 | (1.78) | 6.34 | (1.69) | .007 | 5.45 | (1.79) | 5.10 | (2.27) | .172 | .128 |
Headache index (intensity x duration) | 2341 | (1110) | 2261 | (1140) | .072 | 1880 | (1157) | 1772 | (1288) | .088 | .621 |
Pain threshold | 221 | (96.4) | 215 | (98.7) | .067 | 217 | (78.4) | 211 | (100) | .065 | .979 |
Quality of life
Group A (N = 35) | Group B (N = 37) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Assessment II
|
Assessment IV
|
Assessment II
|
Assessment IV
| p †† | |||||||
d† | d † | ||||||||||
Physical function | 68.6 | (18.0) | 70.7 | (15.7) | .127 | 72.3 | (19.4) | 75.4 | (18.4) | .165 | .434 |
Role physical | 8.57 | (21.0) | 14.3 | (22.1) | .266 | 12.8 | (23.3) | 26.4 | (32.2) | .480 | .107 |
Bodily pain | 25.9 | (17.4) | 26.3 | (14.4) | .025 | 29.5 | (18.6) | 37.7 | (22.8) | .396 | .020 |
General health | 51.7 | (19.8) | 52.5 | (20.8) | .035 | 52.4 | (22.5) | 49.5 | (19.7) | .137 | .355 |
Vitality | 27.9 | (19.0) | 31.0 | (21.3) | .156 | 36.2 | (18.6) | 40.4 | (23.1) | .200 | .480 |
Social function | 35.8 | (24.3) | 44.1 | (24.0) | .347 | 47.0 | (26.3) | 53.7 | (29.4) | .242 | .588 |
Role emotional | 68.6 | (41.2) | 69.5 | (38.2) | .024 | 59.5 | (42.4) | 63.0 | (45.0) | .082 | .776 |
Mental health | 52.7 | (17.4) | 56.6 | (20.0) | .207 | 61.4 | (17.9) | 65.1 | (19.3) | .197 | .716 |
Concussive symptoms
Group A (N = 34) | Group B (N = 37) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Assessment II
|
Assessment IV
|
Assessment II
|
Assessment IV
| p †† | |||||||
d† | d † | ||||||||||
Sum total | 33.4 | (13.8) | 32.0 | (12.6) | .107 | 30.0 | (13.4) | 25.7 | (12.8) | .327 | .054 |
Cognitive factor | 2.49 | (1.47) | 2.63 | (1.43) | .095 | 2.50 | (1.47) | 2.16 | (1.42) | .237 | .039 |
Emotional factor | 1.96 | (1.37) | 1.64 | (1.05) | .265 | 1.48 | (1.07) | 1.25 | (1.02) | .220 | .550 |
Somatic factor | 2.01 | (.817) | 1.95 | (.672) | .079 | 1.83 | (.822) | 1.57 | (.754) | .331 | .027 |
Psychological distress
Group A (N = 34) | Group B (N = 36) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Assessment II
|
Assessment IV
|
Assessment II
|
Assessment IV
| p †† | |||||||
d† | d † | ||||||||||
Somatisation | 62.2 | (7.19) | 61.5 | (7.72) | .099 | 59.3 | (8.08) | 58.7 | (7.77) | .092 | .545 |
Obsession-compulsion | 61.2 | (10.8) | 59.4 | (9.95) | .179 | 58.4 | (10.2) | 57.1 | (10.6) | .126 | .966 |
Interpersonal sensitivity | 55.7 | (9.45) | 52.7 | (11.1) | .300 | 50.2 | (13.1) | 51.1 | (12.2) | .074 | .050 |
Depression | 61.4 | (9.36) | 58.7 | (9.77) | .279 | 57.5 | (8.80) | 55.3 | (10.0) | .233 | .804 |
Anxiety | 60.0 | (8.45) | 57.8 | (11.0) | .223 | 55.3 | (10.4) | 53.5 | (11.1) | .168 | .982 |
Hostility | 60.8 | (7.63) | 56.4 | (10.0) | .505 | 54.4 | (10.3) | 54.3 | (10.6) | .016 | .363 |
Phobic anxiety | 59.2 | (12.5) | 56.5 | (12.8) | .214 | 58.2 | (12.5) | 55.2 | (13.2) | .235 | .790 |
Paranoid ideation | 48.7 | (11.8) | 48.0 | (10.5) | .066 | 50.0 | (10.9) | 48.3 | (11.1) | .151 | .642 |
Psychoticism | 54.0 | (12.4) | 51.8 | (11.7) | .179 | 52.2 | (10.5) | 51.5 | (11.0) | .064 | .588 |
Global severity index | 60.7 | (8.15) | 59.3 | (8.89) | .164 | 57.2 | (9.16) | 55.7 | (9.79) | .153 | .734 |