The ENHANCE Project: Enhanced Treatment for Headache
A Griffith University Clinical Trial
Principle Investigator :
Professor Paul Martin
Professor Peter J. Goadsby
Professor Colin MacLeod
Professor Simon Broadley
Associate Professor John Reece
Dr Sharon Mackenzie (Project Manager)
Siavash Bandarian-Balooch (Research Fellow)
Arissa Brunelli (Project Coordinator)
"Enhancing cognitive-behavioural therapy for recurrent headache by integrating into it a new approach to the management of headache triggers (Learning to Cope with Triggers)"
Funded by the National Health and Medical Research Council
Chronic headache is extremely common and can be very debilitating. This statement is true for both the major types of primary headache – migraine and tension-type headache. Chronic headache is associated with very high direct and indirect costs to society. Cognitive behaviour therapy (CBT) has been demonstrated to be a highly successful form of treatment for chronic headache. This approach includes a number of methods such as relaxation training, pain management techniques, and techniques designed to challenge and modify the dysfunctional thoughts and beliefs that are associated with headaches and the triggers of headaches, such as stress.
A recent NHMRC study the “MaTCH Project”, completed by Professor Martin’s team at Monash University, investigated four treatment options in relation to headache triggers. Participants were randomly allocated to the following groups: (i) Avoid all triggers (Avoid); (ii) Learning to cope with triggers (LCT) (iii) Avoid triggers and cognitive behavioural therapy (Avoid/CBT) and (iv) Waiting-list. Both the Avoid/CBT and the LCT treatment groups gained significant benefits from the treatment provided including a 30.5% to 35.5% decrease in headache severity and a 23.6% to 24.9% reduction in medication usage respectively.
The main aim of this research is further enhance the previous approaches by integrating learning to cope with triggers (LCT) into cognitive behavioural treatment (CBT), and evaluate the efficacy of this new approach (LCT/CBT). The version of CBT is used in treatment is based on a functional model of headaches and triggers. In this model triggers are viewed as the immediate antecedents of headaches therefore facilitating a pragmatic integration into a structured CBT treatment. In previous studies, LCT and CBT were each administered across 8 sessions, but the overlap in the approaches means that the integrated program will be delivered in 12 sessions.
Participants for the research will be recruited from the general public with a target of 150 participants entering the trial, and an expectation that approximately 120 will complete the trial. To be eligible for the trial, participants need to be between 18 and 75 years of age, and diagnosed as suffering from chronic headache (tension-type headache or migraine, for at least 12 months).
Participants will be randomly allocated to LCT/CBT, AVOID/CBT or a waitlist control. Treatment will involve 12, 50-minute sessions, administered individually. All participants in the waitlist control group will be eligible for treatment following the completion of the control period.
Headaches and medication will be measured by the participants keeping daily records via a daily headache diary (either online or paper version) designed for this purpose. Similarly the project aims to utilize online surveys for some of the assessment measures. It is anticipated that options that assist participants to complete assessments in a time efficient manner will improve participant compliance and satisfaction with the reporting requirements of the study. Follow up assessment will include both a four and a 12 month follow-up.
For more information or to participate, please contact our ENHANCE project staff: