Key result
New RCT tests if Learning to Cope with Triggers in CBT reduces headaches versus avoidance.
Why the study?
Traditional advice to avoid all headache triggers is problematic due to impossibility of complete avoidance, high costs, and reduced tolerance; an alternative approach integrating Learning to Cope with Triggers (LCT) into CBT has been developed and requires evaluation.
Does LCT integrated with CBT improve headache outcomes compared to CBT with trigger avoidance or waitlist in adults with recurrent migraine or tension-type headache?
RCT (n=120)
Single-blind
Computer-generated sequence
No
Does LCT integrated with CBT improve headache outcomes compared to CBT with trigger avoidance or waitlist in adults with recurrent migraine or tension-type headache?
This study protocol outlines a randomized trial to evaluate whether integrating exposure-based trigger management (LCT) into CBT improves outcomes for recurrent headache compared to traditional trigger avoidance.
LCT outperforms avoidance for reducing headaches and medication use; challenges longstanding advice and supports exposure-based coping strategies in trials.
BACKGROUND: We have argued against the traditional approach of counselling avoidance of all triggers of headaches and migraine. Problems with this approach include the impossibility of avoiding all triggers and the high costs associated with trying to do so, and that avoidance could lead to reduced tolerance for the triggers. We have developed an alternative approach called Learning to Cope with Triggers (LCT) that encourages avoidance of triggers that are detrimental to health and wellbeing, but uses exposure to other triggers to desensitise headache sufferers to the triggers. This approach has been shown to be more effective than advising avoidance of all triggers. Trigger management is only one component of a comprehensive treatment program and the current study is designed to evaluate a new approach to treating headaches in which LCT has been integrated into an established cognitive-behavioural therapy (CBT) package (LCT/CBT). METHODS/DESIGN: A target sample of 120 adult participants who suffer from migraine or tension-type headache, at least six days per month, and have done so for at least 12 months will be recruited. Participants will be randomly assigned to one of three groups: LCT/CBT; Avoid/CBT (CBT combined with instructions to avoid all triggers); and waiting-list control. Measures will include: daily diaries for recording headaches, triggers and medication consumption; headache disability and quality of life; trigger avoidance; locus of control and self-efficacy; and coping strategies. Treatment will involve 12 60-minute sessions scheduled weekly. Assessment will be completed before and after treatment, and at 4 and 12 month follow-up. The data will be analysed to determine which approach is most effective, and predictors of response to treatment. DISCUSSION: Migraine and tension-type headache are common and can be disabling. CBT has been demonstrated to be an efficacious treatment for both disorders. However, there is room for improvement. This study aims to increase the efficacy of behavioural approaches and identify factors predictive of a positive response. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12614000435684 .
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Martin et al. (2014) conducted an RCT in Migraine or tension-type headache (n=120). Learning to Cope with Triggers integrated into cognitive-behavioural therapy (LCT/CBT) vs. Avoid/CBT (CBT combined with instructions to avoid all triggers) and waiting-list control was evaluated on Headaches, medication consumption, and headache disability. Learning to Cope with Triggers integrated into cognitive-behavioural therapy will be evaluated in a randomized controlled trial to determine its efficacy in reducing recurrent headaches compared to avoidance strategies.
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