One-day behavioral intervention in depressed migraine patients: effects on headache
Open accessAbstract
Objective: To determine whether a 1‐day behavioral intervention, aimed at enhancing psychological flexibility, improves headache outcomes of migraine patients with comorbid depression. Background: Migraine is often comorbid with depression, with each disorder increasing the risk for onset and exacerbation of the other. Managing psychological triggers, such as stress and depression, may result in greater success of headache management. Method: Sixty patients with comorbid migraine and depression were assigned to a 1‐day A cceptance and C ommitment T raining plus M igraine E ducation workshop ( ACT‐ED ; N = 38) or to treatment as usual ( TAU ; N = 22). Patients completed a daily headache diary prior to, and for 3 months following, the intervention. Clinical variables examined included headache frequency/severity, medication use, disability, and visit to a health care professional. Comparisons were made between baseline findings and findings at the 3‐month follow up. Results: Participants assigned to the ACT‐ED condition exhibited significant improvements in headache frequency, headache severity, medication use, and headache‐related disability. In contrast, the TAU group did not exhibit improvements. The difference in headache outcomes between ACT‐ED and TAU was not statistically significant over time (ie, the treatment by time interaction was nonsignificant). These results complement those of a previous report showing effects of ACT‐ED vs TAU on depression and disability. Conclusion: A 1‐day ACT‐ED workshop targeting psychological flexibility may convey benefit for patients with comorbid migraine and depression. These pilot study findings merit further investigation using a more rigorously designed large‐scale trial.
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The efficacy of stress-oriented psychotherapeutic interventions, such as acceptance and commitment therapy and mindfulness, has been shown to be poor.
“the efficacy of stress-oriented psychotherapeutic interventions, such as acceptance and commitment therapy and mindfulness, has been shown to be poor [8–18]”
From Protocol and methods for testing the efficacy of well-being therapy in chronic migraine patients: a randomized controlled trial. (2018) · cites this paper as [13]
The Results (Headache Occurrence & Headache Severity; page unavailable) report significant reductions in headache frequency and severity within the ACT-plus-education group, although the changes did not differ significantly from treatment as usual. The Discussion (page unavailable) calls the initial findings promising, not evidence that ACT or mindfulness interventions have poor efficacy. The study also cannot isolate ACT’s contribution from migraine education. (LLM, conf=0.85)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredBrief ACT has yielded positive long-term outcomes in patients with co-morbidity.
“When presented as a brief intervention, ACT has produced positive long-term outcomes in those with co-morbidity [4, 5].”
From A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study (2015) · cites this paper as [4]
The Introduction reports positive long-term outcomes from brief ACT in patients with several conditions and describes a one-day intervention for patients with comorbid depression and migraine. But the Limitations and Future Directions section calls this study’s three-month follow-up relatively short and says longer follow-up is needed. The paper therefore does not establish long-term outcomes for its comorbid patient group. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMeasures selected in this study mirror those commonly used in treatment outcome trials for chronic migraine and are consistent with the international expert consensus guidelines for determining treatment response.
“Measures selected in this study mirror those commonly used in treatment outcome trials for chronic migraine [9, 13, 15, 16] and are consistent with the international expert consensus guidelines for determining treatment response [35, 36]”
From Protocol and methods for testing the efficacy of well-being therapy in chronic migraine patients: a randomized controlled trial. (2018) · cites this paper as [13]
The Methods > Headache Diary section (page unavailable) shows that this migraine treatment trial measured headache occurrence, severity, medication use, and disability, supporting the citation as an example of outcome measures. But Methods > Participants (page unavailable) specifies 4–12 migraine days in the previous month; the paper does not establish that these measures are commonly used specifically in chronic-migraine trials. The expert-consensus-guidelines clause cites other sources, not this paper. (LLM, conf=0.83)
Experimental — accuracy not yet measuredCurrent evidence on the efficacy of psychological interventions remains limited and unsatisfactory.
“Current evidence on the efficacy of psychological interventions remains limited and unsatisfactory [8–18]”
From Protocol and methods for testing the efficacy of well-being therapy in chronic migraine patients: a randomized controlled trial. (2018) · cites this paper as [13]
The Limitations and Future Directions section identifies design limitations and calls for further study, supporting the view that evidence for this particular intervention remains limited. But the Introduction describes ACT as evidence-based, and the Discussion calls this study’s findings promising; the paper does not characterize evidence for psychological interventions generally as unsatisfactory. No page numbers are available in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredACT has been delivered successfully in various formats, including one-day group workshops.
“has been successfully implemented in varied delivery formats [14–16], including one-day group workshops [17, 18].”
Single-session ACT interventions are gaining empirical support.
“Single session ACT interventions are gaining empirical support [23–26]”
The ROB evaluation revealed 12 studies of low quality, 5 of moderate quality, and 4 of high quality.
“The ROB evaluation revealed that 12 studies were of low quality [93,94,95,98,101,102,103,105,106,107,108,109], 5 were of moderate quality [91,92,96,103,111], and 4 were high quality [97,99,100,110].”
From Effectiveness of acceptance and commitment therapy in central pain sensitization syndromes: A systematic review (2021) · cites this paper as [101]
A pilot study on a 1-day ACT treatment reported that ACT-ED led to significant improvements in headache frequency, headache severity, medication use, headache-related disability, and reduction in visits to healthcare professionals.
“Additionally, a pilot study on a 1-day ACT treatment reported that ACT plus Migraine Education (ACT-ED) led to significant improvements in headache frequency, headache severity, medication use, and headache-related disability, together with a reduction in the number of visits to healthcare professionals [101].”
From Effectiveness of acceptance and commitment therapy in central pain sensitization syndromes: A systematic review (2021) · cites this paper as [101]
Differences in headache outcomes between ACT-ED and TAU groups were not statistically significant over time.
“However, differences in headache outcomes between ACT-ED and treatment-as-usual (TAU) groups were not statistically significant over time (i.e., the treatment by time interaction was non-significant) [101].”
From Effectiveness of acceptance and commitment therapy in central pain sensitization syndromes: A systematic review (2021) · cites this paper as [101]
Some studies confirmed a significant reduction in number of days of headache per month and medication intake per month in ACT groups.
“Some studies also confirmed a significant reduction in the number of days of headache per month, and of medication intake per month, in their ACT groups [94,101].”
From Effectiveness of acceptance and commitment therapy in central pain sensitization syndromes: A systematic review (2021) · cites this paper as [101]
ACT interventions have been associated with improvements in mental health, medical, and behavioral outcomes, and overall functioning and quality of life.
“ACT interventions have been associated with improvements in mental health, medical, and behavioral outcomes, and overall functioning and quality of life (e.g., [79, 80]).”
From Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. (2017) · cites this paper as [80]
In the same migraine study, participants in ACT-ED exhibited significant improvements in headache frequency, headache severity, medication use, and headache-related disability, as reported in daily headache diaries.
“Furthermore, in contrast to the TAU group, participants assigned to the ACT-ED condition exhibited significant improvements in headache frequency, headache severity, medication use, and headache-related disability, as reported in daily headache diaries [33].”
From One-day acceptance and commitment training workshops in medical populations (2015) · cites this paper as [33]
Outcome studies suggest Acceptance and Commitment Therapy's usefulness for headache management.
“Outcome studies suggest ACT's usefulness for headache management.12”
From Acceptance and Commitment Therapy for Primary Headache Sufferers: A Randomized Controlled Trial of Efficacy (2021) · cites this paper as [12]
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- Authors
- Dindo, L., Recober, A., Marchman, J., O' Hara, M. W., & Turvey, C.
- Affiliations
- University of Iowa (US)
- Department of Psychology University of Iowa Iowa City IA USA
- Venue
- Headache: The Journal of Head and Face Pain
- Publisher
- Wiley
- Published
- 2013-10-30
- Volume
- 54
- Issue
- 3
- Pages
- 528-538
- ISSN
- 0017-8748 (ISSN-L)
- 1526-4610
- PMC
- PMC3990866
- OpenAlex
- W2067028832
- Cited by
- 52
- References
- 47
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 2 · 2022: 3 · 2021: 8 · 2020: 3 · 2019: 6 · 2018: 5 · 2017: 6 · 2016: 5 · 2015: 7
- FWCI
- 2.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Headache The Journal of Head and Face Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (K08NS066087)
- National Center for Research Resources (KL2RR024980, UL1RR024979)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- migraine, depression, comorbidities, acceptance and commitment training, psychological flexibility, behavioral interventions, headache frequency, headache severity, headache-related disability
- MeSH terms
- Adult, Behavior Therapy, Depression, Female, Humans, Male, Migraine Disorders, Pilot Projects, Pain Management
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