A short-term education and self-management program for patients with chronic migraine does not lead to improvements in headache-related quality of life, according to study findings published in Neurology.
Current research shows that patients with chronic headache may benefit from psychological and nonpharmacological treatment. Supportive self-management has also shown effectiveness in other chronic pain syndromes; however, there is little evidence that supports its utility in those with chronic headache.
For the study, researchers aimed to evaluate the effectiveness of group educational and supportive self-management programs on the quality of life of patients living with chronic migraine.
The researchers conducted a randomized controlled study, Chronic Headache Education and Self-management Study (CHESS; ISRCTN.com Identifier: ISRCTN79708100), which focused on education and self-management practices in an effort to better manage life with chronic headache.
Participants attended biweekly group sessions focused on promoting behavioral change and learning strategies. Additionally, 1-to-1 sessions and follow-up calls to promote drug management and beneficial lifestyle change was also implemented.
The researchers recruited participants from general practices who had a diagnosis of either chronic migraine, episodic migraine, or chronic tension-type headache. Participants with and without medication overuse headache were also included. Those with headaches requiring specific treatments, such as cluster headache, were excluded from the study.
Primary study outcome was quality of life, measured using the Headache Impact test (HIT-6), given at 6 and 12 months. Secondary outcomes included Chronic Headache Quality-of-Life Questionnaire, which documented limitations and emotional impact of headache. Headache days, severity, and duration were also recorded.
A total of 31,020 people across 166 practices were approached to participate in the study. Of those, 1,159 were eligible; a total of 727 participants were included in the study. The researchers allocated 376 participants to the self-management intervention and 351 received usual care.
According to 12-month follow-up data on 81% of participants, there was no between-group difference of HIT-6 scores (adjusted mean difference, -0.3; 95% CI, -1.23-0.67; P =0.56).
No discernible effect on medication overuse between groups was found, as no differences in proportions using acute mediations ≥10 or ≥15 days in the last 28 days at any follow-up was found.
Between-group difference for number of headache days at 12-month follow-up was 0.2 (95% CI, −0.11 to 0.46; P =0.234). Headache duration difference was found to be 0.4 (95% CI, −0.47 to 1.28; P =0.361), and estimated headache severity difference was 0.2 (95% CI, −0.08 to 0.46; P =0.163).
In patients with chronic migraine, HIT-6 at 12-month follow-up was -0.7 (95% CI −1.97 to 0.65, P =0.325). Patients with chronic tension type headache and episodic migraine also had similar results; HIT-6 at 12 months was −0.1 (95% CI −1.46 to 1.35, P =0.943).
“The trial found no evidence of any clinically relevant benefit from the CHESS intervention across multiple outcomes, at multiple time points, or in any sensitivity or subgroup analyses,” the researchers wrote. They concluded, “Our data effectively exclude the possibility that this short intervention is effective.”
Study limitations included nonattendance in treatment sessions (25% nonadherence to any treatment sessions) as well as possible inclusion of participants who did not meet the criteria for chronic migraine or chronic tension–type headache and episodic migraine.
As the evidence suggests, it still remains essential to identify effective treatments for those living with disabling symptoms of chronic migraine or chronic tension-type and episodic migraine.
Underwood M, Achana F, Carnes D, et al. Supportive self-management program for people with chronic headaches and migraine: a randomized controlled trial and economic evaluation. Neurology. 2023;100(13):e1339-e1352. doi:10.1212/WNL.0000000000201518