Cognitive behavioral therapy in the treatment of patients with chronic migraine and concomitant chronic insomnia: a prospective, randomized trial

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OBJECTIVE

To evaluate the effectiveness of a multidisciplinary program, including Cognitive behavioral therapy (CBT), in the treatment of patients with chronic migraine (CM) and concomitant chronic insomnia (CI).

MATERIAL AND METHODS

The study included 96 patients with CM and CI, average age 35.7±8.6. All patients underwent clinical interviews and testing using clinical and psychological techniques. Patients were randomized into two groups: group 1 received study treatment (an multudisciplinary program including CBT for pain and insomnia, combined with standard treatment for migraine), group 2 received standard treatment for migraine (preventive and acute pharmacotherapy for migraine, recommendations about lifestyle and sleep hygiene). All patients were assessed for clinical and psychological parameters before treatment and at 3, 6, 12 and 18 months follow-up.

RESULTS

At 3 month follow-up a statistically significant improvement was observed in group 1: a decrease in the frequency of headaches and the use of painkillers, parameters on the Insomnia Severity Index (ITI), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory, and the Migraine Disability Assessment (MIDAS) (p<0.05). At 6, 12 and 18 months follow-up the achieved improvements were maintained. At 3 month follow-up, group 2 showed a statistically significant improvement in only 4 parameters: a decrease in the frequency of headaches and painkiller use, and parameters for ITI and MIDAS. These parameters increased to values that were not statistically significantly different from the parameters before treatment in group 2 at 6 month follow-up. At 3 month follow-up in group 165% of patients achieved clinical effect (CE) according to CM (headache frequency decreased by 50% or more), in group 2 — 40%, which was not statistically significantly different (p>0.001); in group 1, 76% of patients achieved CE according to CI (ITI decreased by 8 points or more), which is statistically significantly more than in group 2 with 45% of patients with CE (p<0.001). At 18 month follow-up, in group 1, 81.5% of patients achieved CE according to CM, which is statistically significantly more than in group 2 with 33% of patients with CE (p<0.001); in group 1, 85% of patients achieved CE according to CI, which is statistically significantly more than in group 2, where 38% of patients had CE (p<0.001).

CONCLUSION

High effectiveness of CBT in patients with CM and combined CI was noted.

Keywords:

chronic migraine

chronic insomnia

medication-overused headache

cognitive behavioral therapy

multidisciplinary treatment

therapy

Authors:

Golovacheva V.A.

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-2752-4109

Golovacheva A.A.

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-2845-7323

Fateeva T.G.

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0001-5502-9757

Parfenov V.A.

Sechenov First Moscow State Medical University

SPIN RSCI: 3322-5559
Scopus AuthorID: 57216913889
ResearcherID: AAG-7021-2019
ORCID: 0000-0002-1992-7960

Received:

26.02.2024

Accepted:

11.03.2024

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