'Headstrong': A computer-based cognitive-behavioral intervention for recurrent pediatric headache

Psychological treatments have been shown to be largely effective for recurrent pediatric headache, but the time and cost required to complete such interventions can be prohibitive for many families. Cost-effective approaches to the treatment of this common pediatric pain condition represent a much needed advance for the field.; A randomized wait-list controlled trial was used to evaluate the efficacy of the "Headstrong" intervention, a computer-based cognitive-behavioral intervention for recurrent pediatric headache developed as part of this dissertation. Fifty, children aged 7--12 attending a pediatric neurology clinic for evaluation of recurrent headaches were randomly assigned to the treatment group (standard medical care plus the Headstrong program) or a wait-list control group who received standard medical care only. Data on baseline headache activity were collected using daily headache dairies and brief questionnaires over a 14-day period. Subsequently, participants in the treatment group worked through the Headstrong headache management program on home computers over the course of 4 weeks while those in the waitlist group continued following the prescriptions of their pediatric neurologist. Daily headache activity was then again assessed during 1-, 2-, and 3-month post-treatment follow-up periods.; Data currently available indicate that members of both groups generally attained improvements in overall headache activity, headache-free days, health-related quality of life and headache-related disability. However, children who received the Headstrong program generally had significant improvements above and beyond those in the wait-list group with respect to reductions in headache frequency, duration, and intensity. In addition, there was a significant association between clinically significant improvement and group assignment, with 60% of those in the treatment group attaining clinically significant improvement versus 8% of the wait-list group. Changes in headache index values appeared to be maintained during follow-up and were corroborated by parent proxy daily headache diaries.; Results of the present study provide initial support for the utility of adding an adjunctive self-management psychological intervention to standard medical care for recurrent pediatric headache. The appeal, cost-efficiency, flexibility and apparent efficacy of the CD-ROM intervention format augur well for its continued refinement and use as an adjunctive therapy option for pediatric headache and potentially other pain conditions.