Elsevier

Behaviour Research and Therapy

Volume 73, October 2015, Pages 8-18
Behaviour Research and Therapy

Cognitive behavior therapy for comorbid migraine and/or tension-type headache and major depressive disorder: An exploratory randomized controlled trial

https://doi.org/10.1016/j.brat.2015.07.005Get rights and content

Highlights

  • Headaches and major depressive disorder are commonly comorbid.

  • This study compared a new cognitive behaviour therapy program with routine primary care.

  • The treatment group was significantly superior in terms of decreases in headaches and depression.

  • The treatment group was also superior on measures of anxiety and quality of life.

  • Improvements achieved were maintained at four month follow-up.

Abstract

Numerous studies have demonstrated comorbidity between migraine and tension-type headache on the one hand, and depression on the other. Presence of depression is a negative prognostic indicator for behavioral treatment of headaches. Despite the recognised comorbidity, there is a limited research literature evaluating interventions designed for comorbid headaches and depression. Sixty six participants (49 female, 17 male) suffering from migraine and/or tension-type headache and major depressive disorder were randomly allocated to a Routine Primary Care control group or a Cognitive Behavior Therapy group that also received routine primary care. The treatment program involved 12 weekly 50-min sessions administered by clinical psychologists. Participants in the treatment group improved significantly more than participants in the control group from pre-to post-treatment on measures of headaches, depression, anxiety, and quality of life. Improvements achieved with treatment were maintained at four month follow-up. Comorbid anxiety disorders were not a predictor of response to treatment, and the only significant predictor was gender (men improved more than women). The new integrated treatment program appears promising and worthy of further investigation.

Section snippets

Design

The study employed a split-plot ANOVA design, consisting of one between-subjects factor (Group), and one within-subjects factor (Time). A randomization procedure based on the CONSORT guidelines was used to allocate participants to a treatment group (CBT for recurrent headache and comorbid depression) or control group (routine primary care, RPC). General considerations in the study design were to maximize practicability of the intervention studied for uptake in routine practice by typical

Participant characteristics

Demographic and clinical characteristics of the sample are shown in Table 1. Occupations have been classified according to the Australian and New Zealand Standard Classification of Occupations. One type of headache was identified for 20 participants and two types for 46 participants. The headache diagnoses in Table 1 are the primary diagnoses. Anxiety disorders were diagnosed in 47 participants, and a total of 96 anxiety disorders were identified. Posttraumatic Stress Disorder and Specific

Conclusions

The CBT program was associated with a significant reduction in headaches, and the decrease was significantly different from the RPC control group. The latter finding is unique as the only previous trial of an integrated treatment for comorbid headaches and depression failed to find a significant difference between headache changes in the treatment and control groups (Dindo et al., 2014). The reason for the different findings between the studies is not clear but the two studies did use quite

Acknowledgements

This research was supported by a grant from beyondblue Victorian Centre of Excellence, an initiative of beyondblue and the Victorian Government, administered through Monash University. Thanks to Crown House Publishing for giving permission to use a relaxation CD, as described in the text. Thanks to David Reutens, Leon Piterman, Martin Sharman, Lillian Nejad and Alex Wynd for contributions to the research, and to the clinical psychologists who provided treatment in this study.

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