Cognitive-behavioral therapy in the treatment of patients with chronic migraine and emotional impairment: A prospective randomized trial with a two-year follow-up period

Background. Among patients with chronic migraine (CM), emotional disorders (anxiety, depression) are common, promoting the chronic course of migraine and making treatment challenging. Cognitive behavioral therapy (CBT) is promising in the complex treatment of patients with CM and emotional disorders. However, few randomized studies have been conducted to assess the effectiveness of CBT in this category of patients.

Aim. To evaluate the effectiveness of an interdisciplinary program, including CBT, in the treatment of patients with CM and emotional disorders (anxiety, depression).

Materials and methods. The study included 176 patients with CM and emotional disorders (55 males and 121 females), mean age 36.2 ±8.7 years. All patients underwent clinical interviews, neurological examinations, and testing using clinical and psychological techniques. Patients were randomized into two groups: Group 1 received the standard of care (preventive and acute treatment pharmacotherapy, lifestyle recommendations, physical activity during the day, detoxification therapy in the presence of drug-induced headache – HA) and CBT in the form of 10 individual face-to-face sessions aimed at treating pain, improving emotional state and daily activity; Group 2 received only the standard of care. All patients were evaluated for clinical and psychological parameters before treatment and at 3, 6, 12, and 24 months after the start of treatment.

Results. After 3 months of treatment, a statistically significant (p<0.05) improvement was observed in Group 1: a decrease in the HA frequency, the use frequency and daily doses of painkillers, points of the scale for assessing the effect of migraine on daily activity, the pain catastrophizing scale, the Spielberger-Khanin scale of personal and situational anxiety, the depression scale of the Center for Epidemiological Research. The improvements persisted after 6, 12, and 24 months from the start of treatment. After 3 months of treatment, Group 2 patients showed a statistically significant improvement in only four indicators at Month 3 of follow-up: the HA frequency, the use frequency and daily doses of painkillers, points of the scale for assessing the effect of migraine on daily activity. However, no improvements were observed after 6, 12, and 24 months of follow-up in Group 2. After 3 months of treatment, the clinical effect of CM (decrease in the HA frequency by 50% or more) in Group 1 was reported in 74% of patients vs 44% in Group 2, with a significant difference (p<0.001). After 24 months of follow-up, 80% of patients in Group 1 had a clinical effect regarding CM, and 31% in Group 2.

Conclusion. An interdisciplinary program that includes CBT is significantly more effective than the standard of care for CM and emotional disorders in the short and long term.