Psychosocial and Family Risk in Pediatric Chronic Migraine

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 DESCRIPTION (provided by applicant): Chronic migraine is a common pain condition in childhood associated with significant pain, disability, and suffering. There is growing evidence to support behavioral interventions as first-line treatment in pediatric chronic migraine. However, many youth do not receive behavioral treatment due to barriers related to access and distance from trained professionals. Internet interventions offer an easier way for families to receive behavioral intervention, but may not be intense enough to support behavioral changes for some children. At present, there are no screening tools available to help clinicians determine which children need behavioral intervention and what intensity of intervention is necessary. The long-term goal of this research program is to match youth with chronic migraine to the correct dose of behavioral treatment in order to optimize outcomes and reduce healthcare-related costs. The objective of this application is to adapt and validate a screening tool of psychosocial and family risk in youth with chronic migraine, and to determine feasibility, acceptability [and preliminary efficacy] of technology-delivered behavioral pain treatment. The K23 candidate is an [Assistant Professor] in the Department of Anesthesiology and Pain Medicine at the University of Washington, and a pediatric psychologist in the chronic pain clinic at Seattle Children's Hospital. The candidate is committed to a patient-oriented research career and proposes a five-year training plan supported by an interdisciplinary team of faculty mentors with expertise in psychosocial risk assessment, Internet interventions, clinical trials in pediatric headache, and biostatistics. This award will provide the candidate with specialized instruction in the evaluation of psychosocial and family risk and resiliency, research methods to develop accessible and targeted interventions for pediatric headache, and necessary knowledge to conduct and evaluate clinical trials in pediatric headache populations. The first phase the research plan involves adaptation of a psychosocial risk screening tool for use in youth with chronic migraine, and validation of the adapted tool in [a separate cohort] of 225 children with chronic migraine and their parents. Repeat assessment of psychosocial risk will be conducted at six-months in a follow-up study of this cohort to examine risk status as a longitudinal predictor of headache outcomes and healthcare-related costs. In the second phase of research, two Internet behavioral treatments will be adapted for youth with chronic migraine that vary in intensity (self-guided vs. human support). Subsequently, feasibility, acceptability [and preliminary efficacy] of these interventions [compared to treatment as usual] will be evaluated in a randomized controlled pilot trial with [60] children screened at different levels of psychosocial risk. Data generated from this research will inform a planned R01 proposal focused on the evaluation of accessible behavioral interventions targeted to the psychosocial risk status of children with chronic migraine and their families. Completion of the proposed training will prepare the candidate for a successful independent research career in pediatric headache medicine.