Combination of medication and psychological therapy effective for treating chronic migraines in children

Psychological therapy plus medication appears to be the most effective treatment strategy for chronic migraine in children, but it may take time for the medical system to widely adopt this approach, says an editorial in the current issue of the Journal of the American Medical Association by Mark Connelly, PhD, a pain psychologist and co-director of the Comprehensive Headache Clinic at Children's Mercy Hospital.

Cognitive behavioral therapy can include training on relaxation techniques and cognitive pain coping skills, as well as the use of biofeedback. It has been shown to be a powerful addition to medication for addressing chronic migraine, but reimbursement, limited staffing and lack of specific healthcare professional training are likely to stand in the way of its widespread use, according to Dr. Connelly.

"Even if only half of young people with chronic migraine were able to complete cognitive behavioral therapy, the addition of more than 11 days per month of headache freedom per patient would have a huge impact," said Dr. Connelly, an expert in pediatric pain management. "The medical community will need to be creative to find ways to implement this treatment strategy on a more widespread basis. The benefits at this point are clear."

Chronic migraine is a serious problem for the young, affecting as many as 1 in 60 children and adolescents. Not only are these severe headaches frequent, occurring more than 15 days per month, the symptoms can be overwhelming, including nausea, vomiting, and sensitivity to light and sound. Many of these children experience significant academic, physical and social impairment, yet they rarely receive adequate treatment.

The Comprehensive Headache Clinic at Children's Mercy, which Dr. Connelly co-directs, provides multidisciplinary care for children and teenagers with severe headache disorders such as chronic migraine. The clinic treats patients ages five to 18 who have headaches associated with moderate to severe functional disability or whose headaches have not adequately responded to initial medical treatments.