Behavioral therapy may treat migraines in kids, teens
In an editorial accompanying the new study, Mark Connelly says there had been some evidence that CBT in addition to medication would be effective as treatment for chronic migraines, but that doesn’t mean it will be widely available right away.
“I don’t think right off the bat every provider who sees these kids will have access to people who can help,” Connelly said. He’s co-director of the Comprehensive Headache Clinic at Children’s Mercy Hospitals and Clinics in Kansas City, Missouri.
Children and teens may be unlikely to follow through with a doctor’s recommendation to see a therapist for chronic migraines, he said, and doctors may not have the time or training to properly explain the rationale for CBT.
Also, insurance companies may not pay for CBT and people would need to be trained in the therapy, he noted.
While Powers and his fellow researchers didn’t examine the cost of the program, he said the total cost of treatment may be less than for a typical medical imaging test, such as an MRI.
Frequency
Studies suggest that migraine headaches occur in 5% to 10% of school-aged children in the United States This frequency gradually increases through adolescence and peaks at about 44 years of age. Many people experience spontaneous remission, meaning that the headaches go away on their own for no clear reason.
Gender
The age of onset of migraine headaches is earlier in boys than in girls. From infancy to 7 years of age, boys are affected equally or slightly more than girls. The prevalence of migraines increases during the adolescent and young adult years, during which 20% to 30% of young women and 10% to 20% of young men experience migraines. After menarche (the time when the first menstrual period occurs), a female predominance occurs. This continues to increase until middle age. The frequency of migraines declines in both sexes by 50 years of age.
“You’re talking about the potential of cost being under $2,000 to get these types of results,” Powers said, adding that the ability to spread this type of therapy would also partially depend on whether insurance companies cover it.
Still, Powers said, people may be able to take advantage of the program used in this study if they ask their doctors about CBT.
Connelly, however, said availability of the treatment will still probably depend on doctors’ ability to explain the therapy.
“I think some families will see a summary of the data and potentially pursue it on their own, but more likely it will be providers who need to explain it and push people to do it,” he said.
In the future, Powers said, there may be ways to alter the therapy to make it more accessible. For example, they could modify it to be partially delivered by computer or online.
“We think there are ways through the research on how to improve upon what we’ve done,” Powers said.
SOURCE: JAMA, online December 24, 2013