Behavioral management of the triggers of recurrent headache: A randomized controlled trial
Open accessAbstract
This study was designed to evaluate the traditional advice to headache sufferers to avoid all triggers ('Avoidance'), and a novel approach to trigger management (Learning to Cope with Triggers - 'LCT') that included graduated exposure to selected triggers to promote desensitization. Individuals (84F, 43M) with migraine and/or tension-type headache were assigned randomly to one of four groups: Waiting-list (Waitlist); Avoidance; Avoidance combined with cognitive behavior therapy (Avoid + CBT); and LCT. Changes in headaches and medication consumption (in parentheses) from pre- to post-treatment were (a minus sign indicates improvement): Waitlist, +11.0% (+15.4%); Avoidance, -13.2% (-9.0%); Avoid + CBT, -30.0% (-19.4%); and LCT, -35.9% (-27.9%). Avoidance did not differ significantly from Waitlist on headaches or medication use, but LCT differed significantly from Waitlist on both measures. Avoid + CBT significantly differed from Waitlist on headaches but not medication consumption. In summary, the study failed to find support for the standard approach to trigger management of advising avoidance, but LCT emerged as a promising strategy. LCT resulted in greater improvement than the other three conditions on all measures of headaches and medication consumption, and was the only treatment condition that significantly differed from the waiting-list control condition in terms of treatment responder rate (50% or greater reduction in headaches) and medication consumption.
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There is little evidence to support trigger-avoidance effectiveness.
“Despite their logical rationale, in practice, there is little evidence to support trigger-avoidance effectiveness,46”
From Acceptance and Commitment Therapy for Primary Headache Sufferers: A Randomized Controlled Trial of Efficacy (2021) · cites this paper as [46]
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Cites
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“The exposure-based LCT tended to have higher effects than other behavioral interventions, but some of these differences were marginal (20).”
BackgroundAn Integrative Cognitive Behavioral Therapy Program for Adults With Migraine: A Feasibility Study
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Self-citation
- Authors
- Martin, P. R., Reece, J., Callan, M., MacLeod, C., Kaur, A., Gregg, K., & Goadsby, P. J.
- Affiliations
- Griffith University (AU)
- ACAP University College (AU)
- Monash Medical Centre (AU)
- The University of Western Australia (AU)
- King's College London (GB)
- Corresponding author
- Martin, Paul R.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 61
- Pages
- 1-11
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2007548729
- Cited by
- 116
- References
- 10
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 7 · 2023: 10 · 2022: 8 · 2021: 14 · 2020: 11 · 2019: 12 · 2018: 8 · 2017: 17 · 2016: 8 · 2015: 5 · 2014: 1
- FWCI
- 7.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- RMIT Research Repository (RMIT University Library) (submittedVersion)
- Figshare (submittedVersion)
- Griffith Research Online (submittedVersion)
- Funders
- Monash University (546058)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- headache triggers, migraine, tension-type headache, graduated exposure, desensitization, cognitive behavioral therapy, medication consumption, recurrent headache
- MeSH terms
- Adaptation, Psychological, Adult, Cues, Female, Humans, Internal-External Control, Male, Middle Aged, Migraine Disorders, Cognitive Behavioral Therapy, Treatment Outcome, Tension-Type Headache, Self Efficacy
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