A Cognitive Behavioral Therapy (CBT) Depression Intervention in Persons with Co-occurring Chronic Migraines
Britton, Ashley Joi
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Numerous epidemiological studies have shown a strong co-occurring relationship between chronic headache disorders and psychiatric disorders – particularly depression or anxiety. Epidemiological research has determined that headache disorders are the most prevalent neurological conditions, with significant psychosocial impacts on work, interpersonal well-being and recreational functioning. Prior headache research has repeatedly demonstrated that migraine is associated with significant negative impacts, including reduced quality of life, impaired functioning, and comorbid psychiatric disorders. Specifically, compared with migraine or a psychiatric condition alone, having migraine with co-occurring mental health disorders results in poorer health-related outcomes. Approximately 33 to 50% of chronic headache patients have mild to moderate depression; and traditional headache treatment was proven to be less effective in depressed patients. Antidepressants are well-documented for treatment of chronic daily headache disorders, including migraine and chronic tension headaches. Cognitive Behavioral Therapy was developed in response to changing conceptualizations of both pain and psychological change mechanisms. The psychology of chronic pain is extensive and ranges from attention control and factors influencing performance of important social roles to aspects of identity construction. This study aimed to assess the effectiveness of a CBT intervention targeted to treat the depression in a community sample with co-occurring chronic headache disorders, with the goal of also improving the head pain severity and frequency. Relative to their counterparts in the Control Condition, individuals with frequent migraines and who also met diagnosis for a depressive disorder demonstrated significant reduction in depressive symptoms, headache days and headache-related disability immediately after undergoing a 4-session cognitive-behavioral intervention that targeted depression.