Cognitive‐behavioral therapy reduces headache frequency in chronic migraine

Insomnia is frequently comorbid with a chronic migraine. A new study published in the journal Headache suggests that treatment of this comorbid insomnia with cognitive‐behavioral therapy holds promise for the reduction of headache frequency in people with a chronic migraine.

Previous small trials have suggested that cognitive‐behavioral treatment of insomnia (CBTi) may reduce migraine frequency. Todd A. Smitherman, Department of Psychology, University of Mississippi, Oxford, MS, USA, and colleagues conducted the study to provide a quantitative synthesis of existing CBTi trials for adults with chronic migraine using Bayesian statistical methods, given their utility in combining prior knowledge with sequentially gathered data.

For the study, completer analyses of 2 randomized trials comparing CBTi to a sham control intervention were used to quantify the effects of a brief course of treatment on headache frequency. Change in headache frequency from baseline to the primary endpoint (6‐8 weeks posttreatment) was regressed on group status using a Gaussian linear model with each study specified in the order of completion.

• In a combined analysis of these prior studies, monthly headache frequency of the treatment group decreased by 6.2 days (95%CrI: −9.7 to −2.7) more than the control group, supporting an interpretation that there is a 97.5% chance that the treatment intervention is at least 2.7 days better than the control intervention.


• The analysis supports the hypothesis that at least for those who complete treatment, there is a high probability that individuals who receive CBTi experience greater headache reduction than those who receive a control intervention equated for therapist time and out‐of‐session skills practice.

"Cognitive‐behavioral interventions for comorbid insomnia hold promise for reducing headache frequency among those with chronic migraine. These findings add to a small but growing body of literature that migraineurs with comorbid conditions often respond well to behavioral interventions and that targeting comorbidities may improve migraine itself," concluded the authors.