Optimizing the management of patients with chronic migraine and neck pain: a prospective randomized trial with long-term follow-up

Most patients with chronic migraine (CM) have musculoskeletal neck pain, which maintains the chronic course of migraine and complicates treatment. Cognitive behavioral therapy (CBT) is promising in the complex treatment of patients with CM and cervicalgia. However, few randomized trials have been conducted to evaluate the effectiveness of CBT in CM. The aim of the study was to evaluate the effectiveness of an multidisciplinary program including CBT in the treatment of patients with CM and neck pain. Material and methods. The study included 120 patients with CM and neck pain (41 men and 79 women), average age 35.7 ± 9.2 years. All patients underwent a clinical interview, neurological examination and testing using clinical and psychological methods. Patients were randomized into two groups: group 1 received standard treatment and CBT, group 2 — only standard treatment. All patients were assessed for clinical and psychological indicators before treatment and at 3, 6, 12 and 24 months follow-up. Results. At 3 months follow-up, statistically significant ( p < 0.05) improvement was observed in group 1: decrease in headache frequency, frequency and doses of taking painkillers (PK), neck pain intensity by the Visual Analogue Scale (VAS), the Total pericranial pain score, in the Migraine Disability Assessment (MIDAS), in the Neck Disability Index (NDI), in the Pain catastrophizing scale, the State-Trait Anxiety Inventory, the Center for Epidemiologic Studies Depression Scale. At 6, 12 and 24 months follow-up, the achieved improvements were maintained. In group 2, at 3 months follow-up, statistically significant improvement was observed in only six indicators — headache frequency, frequency and doses of taking PK, neck pain intensity by VAS, MIDAS and NDI. However, at 6, 12 and 24 months of follow-up the achieved improvements were not maintained in group 2. At 3 months of follow-upin group 1 was clinical efficacy (CE) for CM (decrease in headache frequency by 50% or more) and CE for neck pain (decrease in pain intensity by VAS and the NDI by 30% or more) achieved by 75% of patients, in group 2 — 45% ( p < 0.001). At 24 months follow-up in group 1 CE for CM and neck pain was achieved by 80% of patients, in group 2 — 30%. Conclusion. An multidisciplinary program including CBT is significantly more effective than standard treatment for chronic migraine and neck in the short and long term.