Brief cognitive-behavioral group treatment for children's headache. A randomized controlled trial of Internet-based self-help training for recurrent headache in childhood and adolescence. A comparison of psychological and pharmacological treatment of pediatric migraine. A behavioral treatment of young migrainous and nonmigrainous headache patients: prediction of treatment success. Cognitive-behavioral therapy of pediatric headache: are there differences in efficacy between a therapist-administered group training and a self-help format? Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain. Cognitive and relaxation treatment of paediatric migraine. Headstrong: a pilot study of a CD-ROM intervention for recurrent pediatric headache. Therapist-assisted versus self-help relaxation treatment of chronic headaches in adolescents: a school-based intervention. Treatment of nonorganic recurrent abdominal pain: cognitive-behavioral family intervention. A school-based, nurse-administered relaxation training for children with chronic tension-type headache. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Treatment of childhood migraine with autogenic training and skin temperature biofeedback: a component analysis. Non-invasive treatment of vascular and muscle contraction headache: a comparative longitudinal clinical study. The efficacy and efficiency of a self-administered treatment for adolescent migraine. Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. A randomized controlled trial of a cognitive-behavioral family intervention for pediatric recurrent abdominal pain. Nonpharmacological treatment for migraine: incremental utility of physical therapy with relaxation and thermal biofeedback. Does relaxation treatment have differential effects on migraine and tension-type headache in adolescents? A controlled study of minimal-contact thermal biofeedback treatment in children with migraine. Efficacy of cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. [A muscle and vascular oriented relaxation program for the treatment of chronic migraine patients. A randomized clinical comparative study]. Biofeedback-assisted relaxation training for young adolescents with tension-type headache: a controlled study. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. Online psychological treatment for pediatric recurrent pain: a randomized evaluation. Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial. Effectiveness of a single-session early psychological intervention for children after road traffic accidents: a randomised controlled trial. Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: a multisite, single-blind, randomized, controlled clinical trial. A new method for the treatment of recurrent abdominal pain of prolonged negative stress origin. An open study comparing manual therapy with the use of cold packs in the treatment of post-traumatic headache. Management of injection pain in children. Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Effects of unilateral repetitive transcranial magnetic stimulation of the motor cortex on chronic widespread pain in fibromyalgia. Relaxation prophylaxis for childhood migraine: a randomized placebo-controlled trial.
Using a randomized design with a waiting list control condition, we assessed the effectiveness of an abbreviated cognitive therapy group program for headaches in children 7 to 12 years of age. In the treatment condition, small groups of five to eight children were taught relaxation, distraction, visualization, and stress management skills in two 90-minute sessions. Parent groups, seen concurrently, reviewed the children's program and addressed parenting strategies. The waiting list control groups were treated 5 weeks later. Thirty-six children meeting inclusion criteria were included in the study; complete data were available for 29 participants (mean age, 9.4 years; 66% female). DEPENDENT MEASURES: We obtained children's ratings of headache frequency, intensity, duration, and five other variables in a diary kept for 3 weeks before and 3 weeks after treatment. Parent measures were collected once before treatment and once at 3-month follow-up.
                CHILD RATINGS: The control condition showed a significant reduction in children's self-rated headache frequency, while the treatment condition did not. On all other self-reported variables, there were no significant differences between the control and treatment conditions. Two participants in each condition achieved a 50% or greater reduction in a self-rating headache index.
                PARENT RATINGS: Follow-up ratings, obtained over the telephone from parents after the children in both conditions had been treated, indicated that the children in both conditions had experienced reduced intensity, frequency, and duration of headaches and that 82% of the children were using the techniques taught in the program. Fourteen children achieved a 50% or greater reduction in a headache index based on parent ratings.
                Although parents were very positive about the effectiveness of the program, the results for children's self-ratings do not support the use of this highly abbreviated treatment method. Two different self-help training programs (multimodal cognitive-behavioral training (CBT) and applied relaxation (AR)) presented via the Internet were compared with an educational intervention (EDU) in an RCT. Sixty-five children and adolescents (mean age: 12.7 years) with recurrent headache (at least 2 attacks per month) were each assigned to one of the three treatment conditions. The main outcome variables related to changes in headache frequency, intensity and duration as well as the responder rate (50% reduction of headache frequency) and NNTs. Secondary outcome variables were pain catastrophizing and general well-being (depression, psychopathological symptoms and health-related quality of life). All groups showed significant reduction in headache frequency, duration and pain catastrophizing, but not in headache intensity, depression, psychopathological symptoms or health-related quality of life at post-assessment. NNTs were 2.0 for the comparison CBT and EDU; 5.2 for the comparison of AR and EDU at post-treatment. The highest responder rates at post were from CBT (63%), significantly different compared to AR (32%) and EDU (19%), whereas at follow-up no significant differences were found (CBT: 63%, AR: 56%, EDU: 55%) reflecting in the NNTs. The effects remain stable in headache frequency, pain catastrophizing and psychopathological symptoms across all groups at follow-up assessment. CBT showed the highest within-effect size in headache frequency, duration and pain catastrophizing. The results support the use of Internet programs for pediatric recurrent headache, especially given their accessibility and suitability for children and adolescents. Further studies are needed to improve their quality and efficacy.
                Copyright 2009 Elsevier Ltd. All rights reserved. A comparison was carried out of the efficacy of psychological and drug treatments for children with migraine. Forty-three children aged between 8 and 16 years (mean age: 11.3 years) who suffered from migraine received either progressive relaxation or cephalic vasomotor feedback, both with stress management training, or metoprolol, a beta-blocker. Psychological treatment was administered in ten sessions lasting six weeks and the drug treatment lasted ten weeks. Relaxation and stress management training reduced the headache index (frequency x intensity of headache episodes), more effectively than metoprolol with cephalic vasomotor feedback and stress management training in between. An overall improvement over time was found with regard to frequency and intensity of headache episodes and analgesics intake. When comparing pre- to post-treatment data, children treated with relaxation training improved significantly in headache frequency and intensity, whereas those treated with cephalic vasomotor feedback improved significantly in headache frequency and duration as well as mood. The clinical improvement was stable at an 8-months follow-up. We evaluated the outcome of a behavioral treatment package in a clinical setting with a group of young (age: 12-22) headache patients, suffering from migrainous or nonmigrainous. Comparison between the experimental (n = 24) and the waiting-list control group (n = 15) showed a treatment effect on headache frequency and on the headache index. Using a 50% reduction in the headache activity as a criterion for clinical improvement, 52% of the participants in the experimental group had improved clinically at the end of the treatment. The treated participants were found to have maintained significant improvement at 1-year follow-up. The treatment effect was significantly high for nonmigrainous headache patients than for migraineurs. The most important background predictor of outcome was duration of headache history: youngsters with a longer headache history profited less by the treatment than youngsters with a shorter headache history. Family predictors of pre-post improvement were maternal rewarding of illness behavior and mother-child relationship Those youngsters who reported more rewarding and/or a more positive mother-child relationship profited less by the treatment than those who reported less rewarding and/or a less positive mother-child relationship. We conclude that therapists treating young headache patients should be alert to pain-rewarding patterns in the family. The efficacy of cognitive-behavioral training in a therapist-administered group format (TG) and a self-help format (SH) for children with recurrent headache was compared.
                A total of 77 children (10-14 years) were randomly assigned to TG (n=29), SH (n=27) and a waiting-list control group (WC; n=19). TG consisted of eight 90-min sessions with groups of five children. SH was conducted via a written manual in which instructions were given and homework tasks were assigned. In both training formats, the topics covered were identical (e.g., self-monitoring of headache, trigger analysis, relaxation, etc.). Main outcome variables related to changes in headache intensity, duration and frequency as assessed with a diary prior to and following training, as well as at 6-month follow-up.
                Children reported a high degree of satisfaction with the training. No significant differences between the two conditions were found. Differences between treatment groups and WC were statistically corroborated for two headache variables. In both treatments, headache decreased markedly from posttraining to follow-up, with 68-76% of children reporting clinically significant improvement. No differential effects of age, gender or headache diagnosis were found. Changes in self-concept and ability to cope with stress after training point to further positive effects of the intervention.
                The efficiency of the two training formats is nearly identical. The group format, because of its better acceptance, is recommended for practical use. Cognitive-behavioral therapy (CBT) interventions show promise for decreasing chronic pain in youth. However, the availability of CBT is limited by many factors including distance to major treatment centers and expense. This study evaluates a more accessible treatment approach for chronic pediatric pain using an Internet-delivered family CBT intervention. Participants included 48 children, aged 11-17 years, with chronic headache, abdominal, or musculoskeletal pain and associated functional disability, and their parents. Children were randomly assigned to a wait-list control group or an Internet treatment group. Primary treatment outcomes were pain intensity ratings (0-10 NRS) and activity limitations on the Child Activity Limitations Interview, both completed via an online daily diary. In addition to their medical care, the Internet treatment group completed 8 weeks of online modules including relaxation training, cognitive strategies, parent operant techniques, communication strategies, and sleep and activity interventions. Youth randomized to the wait-list control group continued with the current medical care only. Findings demonstrated significantly greater reduction in activity limitations and pain intensity at post-treatment for the Internet treatment group and these effects were maintained at the three-month follow-up. Rate of clinically significant improvement in pain was also greater for the Internet treatment group than for the wait-list control group. There were no significant group differences in parental protectiveness or child depressive symptoms post-treatment. Internet treatment was rated as acceptable by all children and parents. Findings support the efficacy and acceptability of Internet delivery of family CBT for reducing pain and improving function among children and adolescents with chronic pain. The present study compared the efficacy of two active treatments, relaxation training and cognitive coping, with a non-specific placebo control in the treatment of 42 children and adolescents with migraine. The first treatment is a simplified version of progressive deep muscle relaxation; the second, a form of cognitive restructuring involving the alteration of dysfunctional thought processes. The results demonstrated that each active treatment was superior to the non-specific intervention in reducing overall headache activity and frequency but not duration or intensity. There were no differences between the experimental groups, and both continued to improve through a 16-week follow-up period, but the control group did not. Initial level of headache severity was an important factor in treatment outcome, with children with severe headaches responding better than those with milder headaches. Possible reasons for the differential treatment effects are discussed, and the implications for future research are considered. To empirically evaluate a minimal therapist contact CD-ROM pain management program for recurrent pediatric headache developed as part of this study.
                Participants were 37 children aged 7-12 attending a pediatric neurology clinic for evaluation of recurrent headache. Children who were randomly assigned to the treatment group worked through the CD-ROM program on home computers for 4 weeks following baseline assessment, whereas those assigned to the wait-list group continued following the prescriptions of their neurologist. Data on daily headache activity and headache-related disability were collected at baseline and up to 3 months after treatment.
                Children who received the adjunctive CD-ROM program had significant improvements in headache activity above and beyond those in the control group. Results provide initial support for the utility of adding an adjunctive CD-ROM psychological intervention to standard medical care for recurrent pediatric headache and potentially other chronic pain conditions in children. This study compared the relative efficacy of a therapist-assisted relaxation treatment programme with a self-help approach and a self-monitoring condition in the treatment of chronic headaches in adolescents within a school setting. The subjects were 46 high school students, 16-18 years of age, who were randomly assigned to the three treatment conditions. The results indicated that the self-help approach was as effective as the therapist-assisted relaxation condition in reducing the students' headache, and that these findings were maintained at a 5-month follow-up evaluation. The results suggest that the self-help relaxation procedure is a potential low-cost alternative treatment to a more traditional therapist-based intervention condition. We evaluated the efficacy of cognitive-behavioral family intervention in the treatment of crises of pain in children with nonorganic recurrent abdominal pain (RAP) and the thresholds of pain for 17 body surface areas in these children.
                A randomized clinical trial was undertaken with 32 children between the ages of 5.1 and 13.9 years with nonorganic RAP. A group of 15 patients, aged 9.9 +/- 2.2 years (11 girls), received standard pediatric care and cognitive-behavioral family intervention for treatment of pain crises. The control group of 17 children, aged 8.4 +/- 2.0 years (11 girls), received only standard pediatric care. These procedures were undertaken by general pediatricians over 4 monthly sessions. An analog visual scale was used to measure the frequency and intensity of the pain crises per month and a mechanical pressure algometer for the measurement of pain threshold.
                The median frequency of pain crises per month reported by patients at the 3 monthly cognitive-behavioral family intervention sessions was 15, 5, 2 and 2, respectively. In contrast, the median frequency for pain crises per month reported by the control group was 12, 8, 10 and 8, respectively. The difference between the intervention group and the controls was statistically significant for frequency of pain at the second, third and fourth visits. There was no statistical difference for intensity of pain or for measured pain thresholds between the control and the intervention group.
                The cognitive-behavioral family intervention reduced the frequency of pain crises of children with nonorganic RAP. This successful intervention was carried out by the intervention of general pediatricians. Compared the efficacy of a school-based, nurse-administered relaxation training intervention to a no-treatment control condition for children (10-15 years old) with chronic tension-type headache and the outcome at posttreatment and a 6-month follow-up. The study was conducted in a controlled between-group design including 26 schoolchildren who were randomly assigned to the two treatment conditions. Results showed that headache activity in the children treated with relaxation training was significantly more reduced than among those in the no-treatment control group at posttreatment as well as the 6-month follow-up. At these evaluations, 69% and 73% of the pupils, respectively, treated with relaxation had achieved a clinically significant headache improvement (at least a 50% improvement) as compared to 8% and 27% of the pupils, respectively, in the no-treatment control group. Thus, a school-based, nurse-administered relaxation training program seems to be a viable treatment approach for children with chronic tension-type headaches. A multicenter, randomized controlled trial with unblinded treatment and blinded outcome assessment was conducted. The treatment period was 6 weeks with follow-up assessment after treatment, then at 3, 6, and 12 months.
                To determine the effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache when used alone and in combination, as compared with a control group.
                Headaches arising from cervical musculoskeletal disorders are common. Conservative therapies are recommended as the first treatment of choice. Evidence for the effectiveness of manipulative therapy is inconclusive and available only for the short term. There is no evidence for exercise, and no study has investigated the effect of combined therapies for cervicogenic headache.
                In this study, 200 participants who met the diagnostic criteria for cervicogenic headache were randomized into four groups: manipulative therapy group, exercise therapy group, combined therapy group, and a control group. The primary outcome was a change in headache frequency. Other outcomes included changes in headache intensity and duration, the Northwick Park Neck Pain Index, medication intake, and patient satisfaction. Physical outcomes included pain on neck movement, upper cervical joint tenderness, a craniocervical flexion muscle test, and a photographic measure of posture.
                There were no differences in headache-related and demographic characteristics between the groups at baseline. The loss to follow-up evaluation was 3.5%. At the 12-month follow-up assessment, both manipulative therapy and specific exercise had significantly reduced headache frequency and intensity, and the neck pain and effects were maintained (P < 0.05 for all). The combined therapies was not significantly superior to either therapy alone, but 10% more patients gained relief with the combination. Effect sizes were at least moderate and clinically relevant.
                Manipulative therapy and exercise can reduce the symptoms of cervicogenic headache, and the effects are maintained. Using a controlled group outcome design, skin temperature biofeedback with autogenic training and autogenic training only was compared to a waiting list as a treatment for childhood headache. Thirty children with migraine headaches, ages 7 to 18 years were randomly assigned to one of the three conditions. Statistical analyses of headache activity indicated that children in the treatment groups improved in headache frequency and duration but not intensity as compared to the waiting list control group. These findings were consistent through a 6 month follow-up. In terms of clinical improvement, 80% of the biofeedback group, 50% of the autogenics group, and none of the waiting list control group were symptom-free. These findings were discussed in relation to past childhood headache studies and implications for current treatment of children with headaches. The purpose of this investigation was to evaluate the long-term course of non-invasively treated chronic headache. A total of 1015 adult patients with primary diagnosis of vascular/migraine or muscle contraction headache participated in the study investigating symptom frequency and severity over a 36 month period after receiving treatment. Treatment consisted of either: relaxation training (stepwise relaxation/hypnosis/autogenic training/cognitive behavior therapy); biofeedback (thermal/photoplethysmograph/EMG); micro-electrical therapy (TENS/Neurotransmitter Modulation) or multimodal treatment (combination of any of the above two treatments). Seven hundred and ninety-three patients returned sufficient data to be included in the analysis. Patients were randomly assigned to treatment groups and received either short term intervention (15 or less treatments) or long term intervention (greater than 15 treatments). Results indicate that all treatment conditions significantly reduced frequency and intensity of cephalalgia. Repeated measure analysis of variance indicated that grouping variables of Biofeedback treatment, symptoms being evidenced less than 2 years and receiving over 15 treatment sessions best predicted successful intervention. Migraine headaches are frequent in adolescents. Although many adolescents are adequately treated palliatively with analgesics, an important subgroup requires prophylactic treatment. Medical treatments for adolescents with frequent severe headaches is often problematic. Prophylactic pharmacological treatments are often shunned by adolescents and their parents because of concern over drug usage. Moreover, propranolol, the most widely used prophylactic drug with adults, is frequently not effective. Psychological interventions are effective but are costly and often not available. A randomized controlled trial was undertaken to evaluate the efficacy and efficiency of a predominantly self-administered treatment that could be delivered in a very cost-efficient format. Eighty seven adolescents (63 females and 24 males) ranging in age from 11 to 18 years were randomly assigned to receive a self-administered treatment, the same treatment delivered by a therapist or a control treatment. Self-administered and clinic treatment were equally effective and superior to the control treatment. However, the self-administered treatment was substantially more efficient. Both active treatments were durable at 1-year follow-up. Unexplained abdominal pain in children has been shown to be related to parental responses to symptoms. This randomized controlled trial tested the efficacy of an intervention designed to improve outcomes in idiopathic childhood abdominal pain by altering parental responses to pain and children's ways of coping and thinking about their symptoms.
                Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to one of two conditions-a three-session intervention of cognitive-behavioral treatment targeting parents' responses to their children's pain complaints and children's coping responses, or a three-session educational intervention that controlled for time and attention. Parents and children were assessed at pretreatment, and 1 week, 3 months, and 6 months post-treatment. Outcome measures were child and parent reports of child pain levels, function, and adjustment. Process measures included parental protective responses to children's symptom reports and child coping methods.
                Children in the cognitive-behavioral condition showed greater baseline to follow-up decreases in pain and gastrointestinal symptom severity (as reported by parents) than children in the comparison condition (time x treatment interaction, P<0.01). Also, parents in the cognitive-behavioral condition reported greater decreases in solicitous responses to their child's symptoms compared with parents in the comparison condition (time x treatment interaction, P<0.0001).
                An intervention aimed at reducing protective parental responses and increasing child coping skills is effective in reducing children's pain and symptom levels compared with an educational control condition. To investigate whether the combination of standard medical care (SMC) and short-term cognitive-behavioral family treatment (CBT) in the treatment of recurrent abdominal pain (RAP) was more effective than SMC alone.
                Children recently diagnosed with RAP via physician examination were randomized into SMC (n = 29) and SMC plus CBT (n = 40) groups. Outcome measures included multiple dimensions of child and parent reported child pain, somatization, and functional disability, and school absences and physician contacts.
                Children and parents participating in the combined SMC + CBT intervention reported significantly less child and parent reported child abdominal pain than children in the SMC intervention immediately following the intervention and up to 1 year following study entry, as well as significantly fewer school absences. Significant differences in functional disability and somatization were not revealed.
                These results, in combination with previous studies, add support to the effectiveness of CBT intervention in reducing the sensory aspects of RAP. Results are discussed with respect to the cost-benefit of integrated medical and short-term psychological services. The identification of musculoskeletal abnormalities in headache patients has led to the incorporation of physical therapy (PT) into treatment programs for chronic headache. The current studies: (i) investigated the efficacy of PT as a treatment for migraine, and (ii) investigated the utility of PT as an adjunct treatment in patients who fail to improve with relaxation training/thermal biofeedback (RTB). PT alone is not effective in reducing headache, with only 14% of subjects reporting significant headache reduction (mean reduction of 15.6% in comparison with 41.3% in RTB). However, PT may have been a useful adjunct, with 47% of a group of 11 subjects who had failed to improve with RTB reporting improvement with the addition of PT. It is recommended that RTB remain the nonmedical treatment of choice for migraine, and that PT may be a useful adjunct for patients who fail to improve after such treatment. The present study evaluated the effects of relaxation treatment in 36 adolescents aged 13 to 18 years (mean +/- SD, 15.4 +/- 1.55 years) suffering from migraine or migraine and tension-type headache as compared with a waiting-list condition group. The subjects rated various characteristics of migraine and tension-type headache in a diary. Significant reductions were found for total headache sum (P <.05) and intensity scores of total headache activity (P <.05) as well as for migraine intensity (P <.05) for subjects treated with relaxation as compared with those in the waiting-list condition group. However, no significant differences between the two groups were found for tension-type headache. Fifty percent of the adolescents treated with relaxation training attained a clinically significant improvement, compared with 12% of those in the waiting-list condition. It is suggested that treatment goals for migraine and migraine occurring with tension-type headache might be different and that relaxation training also might benefit from focusing on specific aspects of the two headache types. To evaluate the effectiveness of handwarming biofeedback (HWB) and stress management training in comparison to attention (handcooling, HCB) and wait-list control groups. Thermal biofeedback has been used in many pediatric migraine treatment studies and has demonstrated a consistent therapeutic effect. No published studies to date have compared this treatment modality with credible attention control using biofeedback technology.
                Thirty-six children and adolescents (mean age: 12.8 years), as well as the mothers and fathers of these children enrolled in the study, were randomly assigned to the three groups. Thirty-four children completed treatment. Both treatment groups received four sessions of biofeedback training and a portable biofeedback device for home practice. Ratings of treatment credibility showed that the children rated the two treatments as equally credible. Assessment included anxiety and depression questionnaires for the children and both of their parents.
                Children who had been assigned to the HWB group were more likely to achieve clinical improvement in migraine after treatment than the children in the HCB group. Treatment gains were maintained up to 6 months after treatment. Home practice data reflected a general increase in temperature in the HWB group and a decrease in temperature for the HCB group.
                The results of this study confirm the findings of earlier pediatric migraine biofeedback treatment studies and also provide support for the specific effect of treatments including stress management and HWB. Future studies with larger sample sizes will aid in delineating the appropriateness of HCB as a control treatment. There are currently no controlled studies of behavioral interventions for juvenile primary fibromyalgia syndrome (JPFM). In this small-sample randomized study, we tested the efficacy of a behavioral intervention, i.e., coping skills training (CST), for the treatment of adolescents with JPFM. Outcomes tested in this study were functional disability, pain intensity, pain-coping efficacy, and depressive symptoms.
                Thirty patients with JPFM were randomly assigned to 8 weeks of either CST or self-monitoring. Adolescents in the CST condition received training in active pain-coping techniques, while those in the self-monitoring condition monitored daily pain intensity and sleep quality with no instructions about behavior change. After posttreatment assessment, subjects were crossed over into the opposite treatment arm for 8 weeks (so that all adolescents eventually received both CST and self-monitoring) and were reassessed at Week 16.
                At Week 8, adolescents in both conditions showed significant decrease in depressive symptoms and functional disability. Those who received CST showed significantly greater ability to cope with pain than those in the self-monitoring condition and a trend toward decreased pain intensity. At Week 16, adolescents had significantly lower levels of disability and depressive symptoms compared to baseline, but those who received self-monitoring followed by CST seemed to receive the most benefit.
                CST can lead to improved functioning among JPFM patients. Although some of the improvement may be due to increased monitoring and attention, CST provides the specific benefit of improving adolescents' ability to cope with pain. The study compares in a randomized clinical control-group design with a waiting list-and acupuncture therapy control-group the short term (three months) effectiveness of a newly developed psychological biobehavioral treatment program in 30 chronic migraine patients. The results show a significant reduction of vascular and tension related headache-frequency and intensity (primary outcome criteria) in both the acupuncture and psychological treatment condition. The waiting list control-group remained almost unchanged over the whole observation period. The improvement in both treatment conditions remained stable throughout the post therapy period to the three months follow-up, but only the psychological treatment condition revealed a highly significant reduction in the use of all kinds of medication in comparison to the pre-treatment period. Single case analyses showed a slight superiority of the psychological treatment condition over the acupuncture therapy due to a more generalized improvement in all secondary outcome variables (psychological restrictions in every day life, medication, duration of headache). The effect of specific components of the psychological treatment program are examined and possible general implication for a treatment of severely disturbed chronic migraine patients are discussed. Tension-type headache is common in children and adolescents and is generally treated with medication, but emerging literature suggests that various behavioral treatments may provide efficacious alternatives to medication. Juvenile tension-type headache sufferers were randomly assigned to biofeedback-assisted relaxation continued to improve and were superior to the control condition at a 6- and 12-month follow-up (86% versus 50%). Biofeedback-assisted relaxation appears to be an efficacious and durable treatment for juvenile tension-type headache and merits further exploration. To assess the efficacy of chiropractic spinal manipulative therapy (SMT) in the treatment of migraine.
                A randomized controlled trial of 6 months' duration. The trial consisted of 3 stages: 2 months of data collection (before treatment), 2 months of treatment, and a further 2 months of data collection (after treatment). Comparison of outcomes to the initial baseline factors was made at the end of the 6 months for both an SMT group and a control group. Setting: Chiropractic Research Center of Macquarie University.
                One hundred twenty-seven volunteers between the ages of 10 and 70 years were recruited through media advertising. The diagnosis of migraine was made on the basis of the International Headache Society standard, with a minimum of at least one migraine per month.
                Two months of chiropractic SMT (diversified technique) at vertebral fixations determined by the practitioner (maximum of 16 treatments).
                Participants completed standard headache diaries during the entire trial noting the frequency, intensity (visual analogue score), duration, disability, associated symptoms, and use of medication for each migraine episode.
                The average response of the treatment group (n = 83) showed statistically significant improvement in migraine frequency (P < .005), duration (P < .01), disability (P < .05), and medication use (P< .001) when compared with the control group (n = 40). Four persons failed to complete the trial because of a variety of causes, including change in residence, a motor vehicle accident, and increased migraine frequency. Expressed in other terms, 22% of participants reported more than a 90% reduction of migraines as a consequence of the 2 months of SMT. Approximately 50% more participants reported significant improvement in the morbidity of each episode.
                The results of this study support previous results showing that some people report significant improvement in migraines after chiropractic SMT. A high percentage (>80%) of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced. To evaluate the efficacy of a distance treatment delivered through Internet and telephone for pediatric recurrent pain.
                Forty-seven participants (9-16 years of age) were randomly assigned to either an Internet-based treatment or a standard medical care waitlist. Treatment employed a Web-based manual for children and parents with weekly therapist contact by telephone or e-mail. At 1- and 3-month follow-ups, participants were assessed on the outcome variables of pain and quality of life. A 50% reduction in diary pain scores was considered clinically significant.
                Significant between-group differences were found: 71 and 72% of the treatment group achieved clinically significant improvement at the 1- and 3-month follow-ups, respectively, whereas only 19 and 14% of the control group achieved the criterion. No significant differences were found on the quality of life variable.
                Distance methods have considerable potential for making effective treatments more accessible with lower associated costs. Episodic tension-type headache is common and is often treated using manual therapies. Few data exist for the efficacy of these interventions.
                To determine the effects of spinal manipulation therapy on adults with episodic tension-type headache.
                Randomized controlled trial lasting 19 weeks.
                Outpatient facility of a National Health Service-funded chiropractic research institution in Denmark.
                Volunteer sample of 26 men and 49 women aged 20 to 59 years who met the diagnostic criteria for episodic tension-type headache as defined by the International Headache Society.
                Participants were randomized into 2 groups, 1 receiving soft tissue therapy and spinal manipulation (the manipulation group), and the other receiving soft tissue therapy and a placebo laser treatment (the control group). All participants received 8 treatments over 4 weeks; all treatments were performed by the same chiropractor.
                Daily hours of headache, pain intensity per episode, and daily analgesic use, as recorded in diaries.
                Based on intent-to-treat analysis, no significant differences between the manipulation and control groups were observed in any of the 3 outcome measures. However, by week 7, each group experienced significant reductions in mean daily headache hours (manipulation group, reduction from 2.8 to 1.5 hours; control group, reduction from 3.4 to 1.9 hours) and mean number of analgesics per day (manipulation group, reduction from 0.66 to 0.38; control group, reduction from 0.82 to 0.59). These changes were maintained through the observation period. Headache pain intensity was unchanged for the duration of the trial.
                As an isolated intervention, spinal manipulation does not seem to have a positive effect on episodic tension-type headache. Road traffic accidents (RTAs) are the leading health threat to children in Europe, resulting in 355,000 injuries annually. Because children can suffer significant and long-term mental health problems following RTAs, there is considerable interest in the development of early psychological interventions. To date, the research in this field is scarce, and currently no evidence-based recommendations can be made.
                To evaluate the effectiveness of a single-session early psychological intervention, 99 children age 7-16 were randomly assigned to an intervention or control group. The manualised intervention was provided to the child and at least one parent around 10 days after the child's involvement in an RTA. It included reconstruction of the accident using drawings and accident-related toys, and psychoeducation. All of the children were interviewed at 10 days, 2 months and 6 months after the accident. Parents filled in questionnaires. Standardised instruments were used to assess acute stress disorder (ASD), posttraumatic stress disorder (PTSD), depressive symptoms and behavioural problems.
                The children of the two study groups showed no significant differences concerning posttraumatic symptoms and other outcome variables at 2 or at 6 months. Interestingly, analyses showed a significant intervention x age-group effect, indicating that for preadolescent children the intervention was effective in decreasing depressive symptoms and behavioural problems.
                This study is the first to show a beneficial effect of a single-session early psychological intervention after RTA in preadolescent children. Therefore, an age-specific approach in an early stage after RTAs may be a promising way for further research. Younger children can benefit from the intervention evaluated here. However, these results have to be interpreted with caution, because of small subgroup sizes. Future studies are needed to examine specific approaches for children and adolescents. Also, the intervention evaluated here needs to be studied in other groups of traumatised children.
                Clinical Trial Registry: ClinicalTrials.gov: NCT00296842. Juvenile fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain disorder in children and adolescents for which there are no evidence-based treatments. The objective of this multisite, single-blind, randomized clinical trial was to test whether cognitive-behavioral therapy (CBT) was superior to fibromyalgia (FM) education in reducing functional disability, pain, and symptoms of depression in juvenile FMS.
                Participants were 114 adolescents (ages 11-18 years) with juvenile FMS. After receiving stable medications for 8 weeks, patients were randomized to either CBT or FM education and received 8 weekly individual sessions with a therapist and 2 booster sessions. Assessments were conducted at baseline, immediately following the 8-week treatment phase, and at 6-month followup.
                The majority of patients (87.7%) completed the trial per protocol. Intent-to-treat analyses showed that patients in both groups had significant reductions in functional disability, pain, and symptoms of depression at the end of the study, and CBT was significantly superior to FM education in reducing the primary outcome of functional disability (mean baseline to end-of-treatment difference between groups 5.39 [95% confidence interval 1.57, 9.22]). Reduction in symptoms of depression was clinically significant for both groups, with mean scores in the range of normal/nondepressed by the end of the study. Reduction in pain was not clinically significant for either group (<30% decrease in pain). There were no study-related adverse events.
                In this controlled trial, CBT was found to be a safe and effective treatment for reducing functional disability and symptoms of depression in adolescents with juvenile FMS.
                Copyright © 2012 by the American College of Rheumatology. To test the hypothesis that psychological treatment given in combination with somatic treatment can relieve recurrent abdominal pain (RAP) of psychosomatic origin in childhood.
                Stomach Pain Clinic Group A, comprising 25 children receiving a combination of psychological treatment and physiotherapy given by two different persons and Stomach Pain Clinic Group B, comprising 23 children receiving physiotherapy only, were constituted in a randomized manner. Stomach Pain Clinic Group C, including 35 children receiving an integrated combination of psychological treatment and somatic treatment given by the same person was also constituted, as well as a reference group. Treatment outcome was measured by calculating a pain score and tender points (TP) score at inclusion and after 1 year.
                The pain score after 1 year improved significantly in all four groups. Stomach Pain Clinic Groups A and B did not show any significant difference, but Stomach Pain Clinic C had a significantly better outcome than Stomach Pain Clinic Group B. Stomach Pain Clinic Groups A and C had a significant decrease in the TP score after 1 year. Pain scores and TP scores calculated for all Stomach Pain Clinic groups correlated significantly at follow-up after 1 year.
                For children with psychosomatic RAP, a special method for integrated psychological and somatic treatment is probably effective. The results have to be confirmed in a randomized controlled study. These children have a special pattern of TPs related to their disorder, which diminishes with improvement in the disorder. One year after head trauma, 23 patients with post-traumatic headache entered a prospective clinical controlled trial to find out if specific manual therapy on the neck could reduce the headache. The study was completed by 19 patients (83%). Ten patients were treated twice with manual therapy and nine patients were treated twice with cold packs on the neck. The pain index was calculated blindly. Two weeks after the last treatment the mean pain index was significantly reduced to 43% in the group treated with manual therapy compared with the pretreatment level. At follow-up five weeks later, the pain index was still lower in this group compared with the group treated with cold packs, but this difference was not statistically significant. The pain index for all 19 patients was significantly correlated to the use of analgesics as well as to the frequency of associated symptoms (number of days per week with dizziness, visual disturbances and ear symptoms). It is concluded that the type of manual therapy used in this study seems to have a specific effect in reducing post-traumatic headache. The result supports the hypothesis of a cervical mechanism causing post-traumatic headache and suggests that post-traumatic dizziness, visual disturbances and ear symptoms could be part of a cervical syndrome. Researchers have come to understand a great deal about pain mechanisms, especially in the past 30 years. This understanding has spawned the development of a number of psychological pain control strategies which have been extensively assessed for use with adults. Less is known about pain control strategies in children. The purpose of this study was to assess the value of 2 cognitive strategies (suggestion and music distraction) in reducing pain in children. Two hundred children, aged 4.5-6.5 years, receiving routine immunization injections were randomly assigned to one of the intervention groups in this factorial study. The groups were designated as: distraction, distraction with suggestion, suggestion and control. Subjects reported their pain using a 4-point pain scale. Distraction was found to significantly decrease pain whereas suggestion did not. Combining suggestion and distraction did not further enhance pain relief compared to use of distraction alone. Age was found to be an important determinant of the success of distraction. Furthermore, age was found to be related to amount of pain reported by children regardless of type of treatment. The results of this study support the use of music distraction in the reduction of injection pain in children. Thirty-one patients with atypical non-cardiac chest pain which had persisted despite negative medical investigation were treated in a controlled trial of cognitive-behavioural therapy. The average duration of pain was 4.7 years. Patients were randomized to either immediate treatment or as a control to assessment only. Treatment involved teaching patients how to anticipate and control symptoms, and modification of inappropriate health beliefs. The average number of sessions given was 7.2. There were significant reductions in chest pain. limitations and disruption of daily life, autonomic symptoms, distress and psychological morbidity in the treated group as compared with the control group who were unchanged. The assessment-only group were treated subsequently and showed comparable changes. Improvements were fully maintained by both treated groups at four- to six-months follow-up. Non-invasive unilateral repetitive transcranial magnetic stimulation (rTMS) of the motor cortex induces analgesic effects in focal chronic pain syndromes, probably by modifying central pain modulatory systems. Neuroimaging studies have shown bilateral activation of a large number of structures, including some of those involved in pain processing, suggesting that such stimulation may induce generalized analgesic effects. The goal of this study was to assess the effects of unilateral rTMS of the motor cortex on chronic widespread pain in patients with fibromyalgia. Thirty patients with fibromyalgia syndrome (age: 52.6 +/- 7.9) were randomly assigned, in a double-blind fashion, to two groups, one receiving active rTMS (n = 15) and the other sham stimulation (n = 15), applied to the left primary motor cortex in 10 daily sessions. The primary outcome measure was self-reported average pain intensity over the last 24 h, measured at baseline, daily during the stimulation period and then 15, 30 and 60 days after the first stimulation. Other outcome measures included: sensory and affective pain scores for the McGill pain Questionnaire, quality of life (assessed with the pain interference items of the Brief Pain Inventory and the Fibromyalgia Impact Questionnaire), mood and anxiety (assessed with the Hamilton Depression Rating Scale, the Beck Depression Inventory and the Hospital Anxiety and Depression Scale). We also assessed the effects of rTMS on the pressure pain threshold at tender points ipsi- and contralateral to stimulation. Follow-up data were obtained for all the patients on days 15 and 30 and for 26 patients (13 in each treatment group) on day 60. Active rTMS significantly reduced pain and improved several aspects of quality of life (including fatigue, morning tiredness, general activity, walking and sleep) for up to 2 weeks after treatment had ended. The analgesic effects were observed from the fifth stimulation onwards and were not related to changes in mood or anxiety. The effects of rTMS were more long-lasting for affective than for sensory pain, suggesting differential effects on brain structures involved in pain perception. Only few minor and transient side effects were reported during the stimulation period. Our data indicate that unilateral rTMS of the motor cortex induces a long-lasting decrease in chronic widespread pain and may therefore constitute an effective alternative analgesic treatment for fibromyalgia. A randomized controlled trial was used to evaluate the effectiveness of relaxation training in the treatment of paediatric migraine. Relaxation training was compared with-two control groups (psychological placebo and 'own best efforts') in a total of 99 children and adolescents with frequent migraine. Daily recording of the headaches following treatment, three months after treatment and at the one-year follow-up indicated that all three treatments were equally effective. The importance of the use of adequate control conditions which generate equivalent expectancies in pain treatment research was confirmed.
Psychological treatments are effective in reducing pain intensity for children and adolescents (<18 years) with headache and benefits from therapy appear to be maintained. Psychological treatments also improve pain and disability for children with non-headache pain. There is limited evidence available to estimate the effects of psychological therapies on mood for children and adolescents with headache and non-headache pain. There is also limited evidence to estimate the effects on disability in children with headache. These conclusions replicate and add to those of the previous review which found psychological therapies were effective in reducing pain intensity for children with headache and non-headache pain conditions, and these effects were maintained at follow-up.