A migraine can have a debilitating effect on a person’s life. But a new study has revealed some amazing results that can offer hope to those who suffer from chronic migraines.
The study was conducted using children between the ages of 10 and 17 who were assigned to two groups. The experimental group received cognitive-behavioral therapy (CBT) while the control group received education on migraines. Both groups were also given a medication called amitriptyline, which was used to help manage the pain.
Amitriptyline is actually classified as an antidepressant. To be more specific, it is in a class known as tricyclic antidepressants (TCA) which was one of the first types of antidepressant treatments developed. TCAs work by hindering the absorption of two neurotransmitters, serotonin and norepinephrine, by receptors in the brain. Both serotonin and norepinephrine are thought to play a role in the perception of pain, and the blocking effect of TCAs is thought to extend to other receptors central to pain perception. Because of this analgesic effect, TCAs are often used as part of a treatment plan to manage chronic pain.
Side effects from TCAs can be a bit harsher than other antidepressants and for this reason, they are often started at low doses and gradually increased along with blood tests used to closely monitor the level of medication in the bloodstream. Lower dosages are often effective in pain management, which further mediates the severity of the side effects. The benefits of TCAs in chronic pain, like that experienced with a migraine, include a lessened perception of pain and easing of pain related sleep disorders, both of which have high utility in improving the quality of life.
However, on their own, TCAs are not as effective as they are when used in combination with other therapeutic approaches. As this new study has demonstrated, other therapies, specifically CBT are incredibly effective in helping to ease symptoms through guided help in developing coping skills. According to this study, it is the combination of TCAs and CBT that truly offers hope to those who suffer with migraine pain.
CBT is a form of psychotherapy that teaches people about how feelings, thoughts and behaviors influence well-being. For pain management, the focus is on how thoughts and behaviors can influence pain perception and how managing adaptive habits and thinking patterns can mitigate experiences of pain. Techniques such as progressive muscle relaxation and breathing techniques can be used to comfort feelings of pain, allowing them to regain some control over their lives. Learning new thought processes can help people reduce their feelings of helplessness, affording them more autonomy. CBT is also effective in alleviating depression that can be associated with chronic pain.
To speak to the effectiveness in CBT with the reduction of migraine pain in children a look at the statistics must include not only the results at the end of the trial, but the results at the end of the follow-up as well as the participation retention rate. Children participating in the study experienced at least 15 “headache days” per month and the ones assigned to the CBT group were shown to have an average of 11.5 fewer days with migraine pain than when they started the trial. The debilitating nature of the chronic migraine pain was reduced from moderate to severe down to mild or no disability. 66 percent of these children experienced a 50 percent reduction in headache occurrences.
These results lasted. At the one year follow-up, 86 percent maintained a 50 percent reduction rate and 88 percent maintained the lower rate of disability from their pain. There are isolated reports of some of the participants maintaining their improvement over a four year span, though extensive follow-ups have yet to be conducted. However, it is quite notable that the participants in both the experimental and control groups reported high levels of satisfaction with their treatments and headache reduction and the study was able to boast a 90 percent retention rate in participants, despite the one and a half year process of treatment and follow-up.
This study on migraine pain not only offers hope, but spreads awareness about the importance of medical treatment that includes mental health aspects. By bringing the drastic improvements of these children who suffer from chronic migraine pain to the public’s attention it will become easier to persuade insurance companies to cover the treatment. It will also allow medical professionals the information they need to construct a much more effective treatment plan for their patients with chronic migraine pain. These findings are especially helpful for children, who can benefit enormously from developing these coping skills early in life.
By Vanessa Blanchard