Integrating Headache Trigger Management Strategies Into Cognitive-Behavioral Therapy: A Randomized Controlled Trial

Objective: Traditionally, the standard advice to individuals suffering from migraine and tension-type headache was that the best way to prevent headaches is to avoid the triggers. This advice has been challenged in recent years and the Trigger Avoidance Model of Headache has been proposed, which suggests that one pathway to developing a headache disorder is by avoiding triggers resulting in trigger sensitization. The objective of the study was to evaluate a novel intervention for primary headache comprising a new approach to trigger management that includes exposure to some triggers with the goal of trigger desensitization (learning to cope with triggers [LCT]) integrated into a cognitive-behavioral therapy (CBT) program (LCT/CBT). Method: The study was a randomized controlled trial comparing LCT/CBT to the same treatment program but using the traditional approach to trigger management of encouraging trigger avoidance (avoid/CBT), and to a waiting-list/treatment-as-usual control condition (WL/TAU). Adults suffering from primary headache (88 female/35 male) were allocated to the three conditions. Results: The three groups significantly differed from baseline to posttreatment on the primary outcome measure of attack frequency, and LCT/CBT significantly differed from WL/TAU but Avoid/CBT did not. Similar results were obtained on the secondary outcome measures, and treatment gains were maintained at 4- and 12-month follow-up. Conclusions: The results suggest the value of using LCT as a component of a CBT program but were not conclusive as the direct comparisons between the two treatment conditions failed to reach statistical significance. The findings support a study of LCT/CBT with a larger sample.