Comparison of Cognitive Treatments for Headache Pain

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APPLICANT?S DESCRIPTION: Cognitive-behavioral interventions are an effective component of multidisciplinary treatment for patients with pain problems. The critical components for treatment success are not known, nor is it understood why CBT works better for some patients than for others. Very few studies have evaluated the utility of specific components of CBT for pain, and the comparison of cognitive components of CBT is particularly lacking. The first aim of this study is to conduct a randomized control comparison of two cognitive-behavioral interventions for headache pain to a delayed treatment control group. The two cognitive interventions employed will be treatment focused on the reduction of pain-specific dysfunctional cognitions and treatment focused on teaching cognitive coping strategies Participants in this study will be referred by local neurologists and will meet diagnostic criteria for migraine and/or tension-type headache. Comprehensive assessments will be conducted before treatment and following 8 weeks of treatment (primary endpoint). Primary outcome measures will include: self-reported pain intensity and frequency of headaches and pain medication use. Secondary outcome variables will include measures of depression, anxiety, dysfunctional thinking, catastrophizing, cognitive coping and self-efficacy. It is predicted that patients who receive treatment will show significant treatment gains compared to the delayed treatment group. However it is expected that cognitive restructuring will result in greater treatment gains than coping skills training. The second aim of the study is to examine the effect of catastrophizing, a specific individual variable that has been shown to predict pain treatment success. Individuals who score high on measures of catastrophizing display poorer physical and psychosocial functioning. These individuals also evidence poorer response to treatment. It is hypothesized that baseline catastrophizing scores will be a predictor of treatment success. Participants who score higher on a measure of catastrophizing will show less improvement than individuals who score lower on this measure. However, catastrophizers will show greater relative improvement with cognitive restructuring than with coping skills training. Future research will consider the potential effects of combining these treatments as well as the impact of order of component presentation.