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Multimodal behavioral treatment of migraine: An Internet-administered, randomized, controlled trial
University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
Uppsala University.
2011 (English)In: Uppsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 116, no 3, 169-186 p.Article in journal (Refereed) Published
Abstract [en]

Introduction. Multimodal approaches in behavioral treatment have gained recent interest, with proven efficacy for migraine. The utility of the Internet has been demonstrated for behavioral treatment of headache disorders, but not specifically for migraine. The aim of the study was to develop and evaluate an Internet-based multimodal behavior treatment (MBT) program for migraine and to test hand massage treatment as an adjunct. Methods. Eighty-three adults, 58 women and 25 men, with at least two migraine attacks a month were recruited via advertisements. An MBT program aiming at improvements in life-style and stress coping was developed for this study and, together with a diary, adapted for use over the Internet. Participants were randomized to MBT with and without hand massage and to a control group, and were followed for 11 months. Questionnaires addressing issues of quality of life (PQ23) and depressive symptoms (MADRS-S) were used. Results. A 50%, or greater, reduction in migraine frequency was found in 40% and 42% of participants of the two groups receiving MBT (with and without hand massage, respectively), who statistically were significantly more improved than participants in the control group. No effect of hand massage was detected, and gender did not show any independent contribution to the effect in a multivariate analysis. Conclusions. MBT administered over the Internet appears feasible and effective in the treatment of migraine, but no effect of hand massage was found. For increased knowledge on long-term effects and the modes of action of the present MBT program, further studies are needed.

Place, publisher, year, edition, pages
2011. Vol. 116, no 3, 169-186 p.
Keyword [en]
Cognitive behavioral treatment, hand massage, Internet, migraine, multimodal, stress
Identifiers
URN: urn:nbn:se:hig:diva-10251DOI: 10.3109/03009734.2011.575963ISI: 000292920200002Scopus ID: 2-s2.0-79960687659OAI: oai:DiVA.org:hig-10251DiVA: diva2:442566
Available from: 2011-09-21 Created: 2011-09-21 Last updated: 2012-09-12Bibliographically approved
In thesis
1. Migraine and Stress: An Internet administered Multimodal Behavioral Treatment Intervention
Open this publication in new window or tab >>Migraine and Stress: An Internet administered Multimodal Behavioral Treatment Intervention
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Migraine is a disabling neurological disorder with high prevalence, the clinical manifestations of which are highly dependent on stress.

The overall theme of the present thesis was to address aspects of stress in migraine. A multimodal behavioral treatment (MBT) program was developed specifically designed for migraine and focusing on stress as a trigger and an intervention was performed using this Internet-administered program. Migraine symptoms were followed via an Internet administered diary and questionnaires were answered at regular intervals during the 11-month study period.

The thesis is based on four papers: In Paper I, life events and current stress, personality traits, and gender were studied cross-sectionally in 106 women and 44 men with migraine, who suffered at least two attacks a month at inclusion. Paper II describes a randomized controlled trial of the MBT program performed on 58 women and 25 men recruited from participants of the study described in Paper I. In the MBT study participants were randomized into one control group and two MBT groups, one of which received hand massage as part of the treatment. In Paper III, complete migraine drug use and changes in use and in drug efficacy during the MBT program were studied. In Paper IV, the salivary cortisol levels of MBT participants were evaluated as a biological stress marker.

The MBT program proved effective in decreasing migraine headache; it was feasible and there was low attrition. Moreover, MBT resulted in decreased migraine drug use and increased drug efficacy, but had no discernible effects on salivary cortisol profiles. No effect of hand massage on migraine headache frequency was seen. Personality trait profiling revealed high scores for the neuroticism factor. Stress susceptibility was the single most aberrant personality trait and correlated highly with the reported level of current stress and with experienced negative life events.

Gender differences included higher scores for women on trait anxiety, negative life events, depressive mood, anxiety, tension type headache, use of triptans, and efficacy of analgesics, whereas men displayed higher use of analgesics.

In conclusion, the efficacy and low attrition associated with the present MBT program appears promising and timely with regard to the development of better and more accessible migraine treatment. Stress susceptibility, gender, negative life events and psychosomatic comorbidity are important factors to consider in relation to the care of persons with migraine.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 73 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 695
Keyword
Awakening Cortisol Response, Cognitive Behavioral Treatment, Gender, Hand Massage, Internet, Life Events, Migraine, Multimodal, Personality, Salivary Cortisol, Stress, Stress Marker, Stress Susceptibility
National Category
Neurology
Research subject
Neurology
Identifiers
urn:nbn:se:hig:diva-12847 (URN)978-91-554-8139-1 (ISBN)
Public defence
2011-10-14, Rosénsalen ingång 95, Barnsjukhuset, Akademiska sjukhuset, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2012-09-12 Created: 2012-09-11 Last updated: 2013-05-27Bibliographically approved

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