June 18, 2002 SEATTLE -- A new study of migraine headaches suggests behavioral therapy "not medication -- may be the most effective weapon against migraine pain for teen-agers.
Researchers with the Ohio University Headache Treatment & Research Project enrolled 30 teens ages 12 to 17 in the pilot project. Half were treated with triptans -- a fairly new class of drugs widely used for migraine in adults -- and half were assigned to a phone-administered behavioral therapy program that included instruction in biofeedback and a variety of relaxation exercises.
Eighty percent of the kids receiving behavioral therapy recorded a decrease of more than half in the number of migraines per month, according to project manager Connie Cottrell, who will present the findings at the American Headache Society annual meeting June 21 in Seattle. Teens in this group also recorded an 80 percent reduction in the hours of activities missed due to migraine pain.
These preliminary results have prompted the researchers to begin plans for a larger study of the treatment of migraines in teens. The planned project will be modeled after a National Institutes of Health-sponsored adult migraine study currently under way at the university's headache clinics in Athens and Columbus.
Migraines are a debilitating health problem that affect some 8 million children and adolescents, resulting in more than 1 million lost school days each year, according to the JAMA Migraine Information Center. At the beginning of the study, participants in this pilot project, who kept daily diaries about their headaches, recorded an average of 3.3 migraines a month with moderate to severe pain. The teens also recorded an average of 5.1 hours per month when their headaches prevented them from participating in a variety of activities.
"Some of these kids were in so much pain, they were just tearful," Cottrell said. "There was one boy whose parent told me would just lie on the bed, hold his head and cry because the pain was so bad."
Studies over the years have revealed a lot of information about the prevention, onset and treatment of migraines in adults. But even though the peak onset for migraine headaches is around 15 years of age, there is less research on migraines in children and teens.
"The triptan therapies have proven very helpful for adults, but it has not been determined if they will be as effective for treating migraines in teens," said Ken Holroyd, a professor of health psychology at Ohio University who started the Headache Treatment and Research Project in 1975. "Triptans are promising treatments for teens. However, if teens can learn to control migraines without medication, this could save decades of medication consumption."
More than 60 kids called to participate in this pilot study, but only 30 who fit the criteria -- two to eight headaches a month that lasted at least four hours each -- were able to commit to the 16-week project.
During the first four-weeks of the study, all 30 participants kept a daily diary of their headache pain, recording the frequency and severity of their migraines. The teens also were seen by the headache project?s neurologist, Dr. Frank O?Donnell.
Participants were then randomly assigned to one of two eight-week treatment groups. Those in the drug therapy group were prescribed triptans, a class of drugs widely used for migraine in adults. The researchers called teens in this group once every two weeks to monitor the effects of the drug.
Those in the behavioral therapy group were given a manual written by Cottrell called "STOP" (Strategies to Take Out the Pain), which included information on ways to identify early signs of migraine and how to manage the triggers that bring on the pain. The book also offered training in relaxation, biofeedback and stress management. Teens read a chapter each week and discussed what they learned during a 20- to 30-minute phone conversation with project leaders.
This contact likely was key to the success of the behavioral therapy, said Cottrell, who noted that although stereotypes sometimes suggest teens have little to say to adults, teens in this study were eager to talk about their migraines.
"Most people who have headaches want to talk about them because they're used to no one listening to them," she said. "I didn't have any problems getting them to talk about their headaches. Some of the teen-agers didn?t do all the reading they were supposed to and in those cases, we talked about what they should have read over the phone so they were exposed to the information."
But for the most part, teens in the study were eager to learn to control their headaches, Cottrell said. The teens also responded favorably to biofeedback therapy, which, in this project, involved a small electronic thermometer that attached to a teen's finger to measure body temperature. Kids were taught how to increase the temperature in their fingers, a process that triggers blood vessels in the head to relax, lessening headache pain.
"Interestingly enough, it was a lot easier for the teen-agers to do the biofeedback than for adults," Cottrell said. "Maybe it was because it uses a computer and kids thought it was cool or maybe kids are more open-minded."
Kids' response to biofeedback is one of several things Cottrell hopes a larger study of migraines in teens will help her understand. She also wants to devise a plan that would help parents become more involved in the treatment of their kids' migraines and to design an instructional tool that would do a better job of keeping teens' attention.
"There has to be a way to get more parental involvement and support for the teen and a more enticing and attractive way to get the message to the teen-agers," Cottrell said. "Reading it in a book is too old-fashioned for young people."
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