Telephone Based Motivational Interviewing May Increase Behavioral Therapy Initiation in Migraine

Motivational interviewing is a widely used method to help patients explore and overcome ambivalence to enact positive life changes. Telephone-based motivational interviewing may improve a patient’s rate of initiating behavioral therapy for treatment of migraine, according to study results published in Headache.

Biofeedback, cognitive behavioral therapy, and relaxation have long-lasting benefits for patients with migraine; however, many patients do not seek these treatments for reasons such as lack of time and health insurance. Telephone-based motivational interviewing has been linked to improvements in headache frequency, though this intervention has not been well studied in the migraine patient population. The objective of this study was to determine whether telephone-based motivational interviewing improved initiation, scheduling, and attendance of behavioral therapy for migraine.

In this single-blind, randomized study, researchers compared the impact of telephone-based motivational interviewing with treatment as usual in 76 adults with migraine. Patients were excluded from the study if they did not have a phone number or had received behavioral therapy for migraine at any time during the past year. Patients assigned to the motivational interviewing group received up to 5 phone calls, whereas patients assigned to the treatment as usual group received 1 call after 3 months for follow-up data. The primary outcome was scheduling of a behavioral therapy appointment, and secondary outcomes included initiating and attending behavioral therapy appointments.

Results revealed that of the 76 patients who met the study criteria, 36 received motivational interviewing, and 40 received treatment as usual. After including only the patients who could be reached at follow-up, there were 59 patients (32 in the motivational interviewing group and 27 in the treatment as usual group). Of these 59 individuals, 30.5% (n=18) scheduled a behavioral therapy appointment and 22% (n=13) attended at least 1 appointment by 3 months after receiving a referral. Patients who received motivational interviewing were more likely to initiate making an appointment compared with patients who received treatment as usual (68.8% vs 40.7%, P =.031), but were not more likely to schedule or attend an appointment (P =.204 and P =.974, respectively). The most common reasons stated for not initiating behavioral therapy included lack of time, lack of funding, travel plans, and prioritization of other treatments above behavioral therapy.

Limitations to this study include a lack of generalizability, lack of power calculation, and small sample size. Additionally, researchers assessed only the use of motivational interviewing with respect to the initiation, scheduling, and attendance of behavioral therapy for migraine.

The study researchers concluded that telephone-based motivational interviewing of patients with migraine may improve rates of behavioral therapy in this population, though future work should focus on finding ways to reduce patient barriers to participation in behavioral therapies for treatment of migraine.

Reference

Minen MT, Sahyoun G, Gopal A, et al. A pilot randomized controlled trial to assess the impact of motivational interviewing on initiating behavioral therapy for migraine. Headache. 2020;60(2):441-456