Therapy plus amitriptyline reduces migraine days

Cognitive behavioral therapy (CBT) combined with amitriptyline results in fewer days with headache and migraine disability in kids and teenagers with chronic migraine than does education about migraines and the tricyclic antidepressant.

The finding comes from a new randomized clinical trial. Researchers in Cincinnati, Ohio, studied 135 children (79% female) aged between 10 and 17 years who suffered with migraines at least 15 days per month and who had a Pediatric Migraine Disability Assessment Score (PedMIDAS) greater than 20 points. All the participants received 1 mg/kg/d amitriptyline. In addition, approximately half received 10 sessions of CBT, while the remainder received 10 sessions of headache education.

When the study began, the participants spent a mean 21 days out of every 28 days with a headache, and their mean PedMIDAS score was 68 points. After 20 weeks, the CBT plus amitriptyline group experienced 11.5 fewer days with headache per 28 days, while the education group experienced 6.8 fewer days with headache per 28-day period. In addition, the PedMIDAS score for the CBT group decreased by 52.7 points, while the score for the education group decreased by 38.6 points.

Two-thirds (66%) of the CBT group experienced a 50% or greater reduction in headache days versus one-third (36%) of the headache education group. One year later, 86% of the therapy group still had a 50% or greater reduction in headache days versus 69% of the education group. Eighty-eight percent of the therapy group had a PedMIDAS score of less than 20 points versus 76% of the education group.

The author of an editorial about the trial agrees with the trial investigators’ conclusion that CBT combined with medication should be considered a first-line treatment for children with chronic migraine.

On a related note, a recent study from Tel Aviv University finds that gum chewing plays a significant role in migraine headaches in teenagers. Out of 30 patients who participated in the study, 26 reported significant improvement and 19 reported complete headache resolution upon ceasing gum chewing. Those who resumed chewing gum reported an immediate return of symptoms. 

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