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Cited by 12Migraine and Headache StudiesMusculoskeletal pain and rehabilitationTemporomandibular Joint Disorders

A Pilot Randomized Controlled Trial to Assess the Impact of Motivational Interviewing on Initiating Behavioral Therapy for Migraine

Open access
Minen, Mia T., Sahyoun, Gabriella, Gopal, Ariana, Levitan, Valeriya, Pirraglia, Elizabeth, Simon, Naomi M., Halpern, Audrey·2020·Headache The Journal of Head and Face Pain
DOI 10.1111/head.13738PMC PMC7754247
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Abstract

Background: Relaxation, biofeedback, and cognitive behavioral therapy are evidence-based behavioral therapies for migraine. Despite such efficacy, research shows that only about half of patients initiate behavioral therapy recommended by their headache specialists. Objective: Motivational interviewing (MI) is a widely used method to help patients explore and overcome ambivalence to enact positive life changes. We tested the hypothesis that telephone-based MI would improve initiation, scheduling, and attending behavioral therapy for migraine. Methods: Single-blind randomized controlled trial comparing telephone-based MI to treatment as usual (TAU). Participants were recruited during their appointments with headache specialists at two sites of a New York City medical center. Inclusion criteria: ages from 16 to 80, migraine diagnosis by United Council of Neurologic Subspecialty fellowship trained and/or certified headache specialist, and referral for behavioral therapy for prevention in the appointment of recruitment. Exclusion criteria: having done behavioral therapy for migraine in the past year. Participants in the MI group received up to 5 MI calls. TAU participants were called after 3 months for general follow-up data. The prespecified primary outcome was scheduling a behavioral therapy appointment, and secondary outcomes were initiating and attending a behavioral therapy appointment. Results: 76 patients were enrolled and randomized (MI = 36, TAU = 40). At baseline, the mean number of headache days was 12.0 ± 9.0. Self-reported anxiety was present for 36/52 (69.2%) and depression for 30/52 (57.7%). Follow-up assessments were completed for 77.6% (59/76, MI = 32, TAU = 27). The mean number of MI calls per participant was 2.69 ± 1.56 [0 to 5]. There was a greater likelihood of those in the MI group to initiating an appointment (22/32, 68.8% vs 11/27, 40.7%, P =.0309). There were no differences in appointment scheduling or attendance. Reasons stated for not initiating behavioral therapy were lack of time, lack of insurance/funding, prioritizing other treatments, and travel plans. Conclusions: Brief telephone-based MI may improve rates of initiation of behavioral therapy for migraine, but other barriers appear to lessen the impact on scheduling and attending behavioral therapy appointments. © 2020 American Headache Society

Integrity signals

Registry

Crossref · 10.1111/head.13738

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

9 of 43 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Study design and conductcitation

    This pilot study did not have a power calculation.

    “This was a pilot study which like other pilot studies of MI did not have a power calculation. 31,32”
    • Also stated in: § Limitations · plain
      “This was a pilot study which like other pilot studies of MI did not have a power calculation. 31,32”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [31] source

      In “Sample Size Determination in Designing a Pilot Study,” the paper says power analyses should not be presented for pilot studies that do not propose inferential tests; sample size should instead reflect feasibility needs. It does not establish whether the citing authors’ particular study, or other MI pilot studies, actually omitted a power calculation. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [32] source
  • Study design and conductcitation

    Pilot sample size was based on pragmatics of recruitment and requisites for examining feasibility.

    “As indicated by Kraemer and colleagues, 33 our pilot sample size was based on the pragmatics of recruitment and the requisites for examining feasibility.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [33] source

      The Conclusion describes the studies it reviews as small pilot or feasibility studies, but does not explain how a pilot sample size was chosen. Searches for recruitment pragmatics, feasibility requirements, and sample-size determination found no passage addressing the cited rationale. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Findingown data

    76 patients were enrolled and randomized (MI=36, TAU=40).

    “76 patients were enrolled and randomized (MI=36, TAU=40).”
    Quote in the paperSubstantial claim
  • Findingown data

    The MI group was more likely than TAU to initiate making an appointment (68.8% vs 40.7%; chi-square=4.7, p=0.031; OR=3.20, 95% CI 1.10-9.34).

    “Our pilot study results revealed that those in the MI groups were more likely to initiate making an appointment (Table 3, 22/32 (68.8%) vs. 11/27 (40.7%), chi-square=4.7, p=0.031, OR=3.20, OR 95%CI: 1.10 to 9.34)”
    Quote in the paperSubstantial claim
  • Findingown data

    There were no differences between MI and TAU in appointment scheduling or attendance.

    “There were no differences in appointment scheduling or attendance.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 65
  • May combine two claims. 41

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    MI is the most widely disseminated evidence-based practice for substance abuse, with more than 80 randomized trials supporting its effectiveness.

    “MI is the most successfully disseminated evidence-based practice for substance abuse, with over 80 randomized clinical trials (RCTs) supporting its efficacy, 10 and long-term benefits (>1 year), 11”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • Classified as probably not a substantial claim.

    Premisecitation

    MI can serve as a pre-treatment intervention to motivate people to attend counseling.

    “MI is an opportunity for health promotion when patients are not motivated but might be amenable to an intervention as it can be a pre-treatment intervention to motivate people to attend counseling.”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • Classified as probably not a substantial claim.

    Premisecitation

    People already seeking treatment are considered motivated in the stages of change model, in the preparation or action stage.

    “People who are already seeking treatment would be considered motivated in the stages of change model, and thus in the “preparation” or “action” stage which is the desired outcome in successful MI interventions. 18”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many studies have delivered MI by telephone.

    “While MI was originally developed as a counselling style to be delivered in-person, there have been many telephone based MI studies. 13”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [13] source

      The Sample and inclusion procedures section says telephone calls were used for three-month follow-up interviews, not to deliver motivational interviewing. A search for telephone-based MI delivery found no passage in our copy addressing whether many such studies exist. (LLM, conf=0.77)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Telephone interventions were previously found to be a novel, low-cost, and appropriate tool for healthcare settings.

    “Previously, telephone interventions were found to provide a novel method and to be of low cost and an appropriate tool for use in healthcare settings. 35”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [35] source

      The Abstract (page unavailable) describes telephone-administered psychotherapy as an increasingly used way to deliver mental health care, supporting its use in healthcare settings. It does not establish that the intervention is low-cost. The Discussion (page unavailable) calls it promising but says more research is needed before broader clinical recommendations, so describing it as an appropriate tool without qualification overstates the paper. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Several studies found that psychological therapies delivered by telephone were as effective as face-to-face treatment, had comparable therapeutic alliance, and satisfied participants.

    “Several studies have demonstrated that psychological therapies delivered by telephone were as effective as face-to-face treatment,37 therapeutic alliance was comparable, and participants were satisfied with this model of delivery. 38”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [37] source

      The Methods > Procedures passage says participants were screened by phone, but the intervention interviews took place in a research laboratory. Searches for telephone-delivered therapy, comparable therapeutic alliance, and participant satisfaction found no passage addressing those claims. No page numbers are available in our copy. (LLM, conf=0.77)

      Experimental — accuracy not yet measured
    • cites [38] source

      The sections on tracking behavioral-therapy adherence and adherence in other disease states (pages unavailable) discuss internet-based treatment and mobile tools, but do not report telephone therapy being as effective as face-to-face treatment. Searches for telephone delivery, therapeutic alliance, and participant satisfaction found no passage addressing those comparisons. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Mean number of MI calls per participant was 2.69±1.56 (range 0 to 5).

    “The mean number of MI calls per participant was 2.69±1.56 [0 to 5].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Self-reported anxiety was present in 36/52 (69.2%) of participants.

    “Self-reported anxiety was present for 36/52 (69.2%) and depression for 30/52 (57.7%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Follow-up assessments were completed for 77.6% (59/76, MI=32, TAU=27).

    “Follow up assessments were completed for 77.6% (59/76, MI= 32, TAU=27).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Self-reported depression was present in 30/52 (57.7%) of participants.

    “Self-reported anxiety was present for 36/52 (69.2%) and depression for 30/52 (57.7%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    At baseline, mean number of headache days was 12.0±9.0.

    “At baseline, the mean number of headache days was 12.0±9.0.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most participants scored in the moderate or higher range on the PHQ-8 for depression and the GAD-7 for anxiety.

    “The majority of participants scored moderate or higher on the PHQ-8 for depression and on the GAD-7 for anxiety.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Headache days, pain intensity, age, depression, anxiety, and MIDAS scores were not normally distributed.

    “Headache days, pain intensity, age, depression, anxiety and MIDAS scores were not normally distributed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Responses to the importance and confidence questions about managing headaches were not normally distributed.

    “The responses to the questions regarding importance/confidence in managing the headaches were not normally distributed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Among those who had not done evidence-based behavioral therapies, 25.4% (15/59) reported a prior recommendation to try behavioral therapy for headache.

    “Of those who had not done any of these evidence based behavioral therapies, about one quarter (15/59; 25.4%) reported having previously received a recommendation to try behavioral therapy for the treatment of headache.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    88.0% (66/75) had previously been evaluated or treated by neurologists for headaches.

    “As shown in Table 2, the vast majority of patients had previously been evaluated and/or treated by neurologists for headaches (66/75; 88.0%)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Three UCNS-certified headache specialists saw 307 patients with headache during an 11-week recruitment period from June 4 to August 20, 2018.

    “Three UCNS Certified Headache Specialists participated in the study which was conducted over an 11 week time period from June 4, 2018 to August 20, 2018. As seen in Figure 1, 307 patients with headache were seen by these three providers during the recruitment period.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The mean time spent on each MI call was 12.10±5.13 minutes, with a range of 4 to 28 minutes.

    “The average time spent on each MI call was 12.10±5.13[4 to 28] minutes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the MI group, themes for scheduling behavioral therapy were previous treatments being unpleasant or ineffective, positive attitudes toward behavioral therapy, and recommendation by a doctor.

    “As seen in Table 4, themes in the MI group for why patients scheduled behavioral therapy were: Previous Treatments Have Been Unpleasant/Ineffective, Positive Attitudes Towards Behavioral Therapy, and Recommended by Doctor.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the MI group, themes for not scheduling behavioral therapy were time as a barrier, cost as a barrier, doubt that behavioral therapy would work, difficulty accessing or initiating appointments, no reason to do behavioral therapy, and considering or using other treatment options.

    “Themes for why those in the MI group did not schedule behavioral therapy were: Time as a Barrier, Cost as a Barrier, Does Not Think Behavioral Therapy Will Work, Difficulty Accessing or Initiating appointments, No Reason to do Behavioral Therapy, and Considering or Using Other Treatment Options.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Patients received a mean of 2.69±1.56 MI calls, with a range of 0 to 5.

    “Patients received an average number of 2.69±1.56 [0 to 5] MI calls.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The median number of headache days per month was 10, with an interquartile range of 5 to 15.

    “Median number of headache days/month was: 10 [IQR: 5 – 15].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was no difference between MI and TAU in scheduling (p=0.204) or attending the appointment (p=0.974).

    “but there was no difference between groups in scheduling (p= 0.204) or attending the appointment (p=0.974).”
    • Also stated in: § Discussion: · plain
      “However, MI did not change the rate in which the patients in the MI arm actually scheduled or attended their behavioral therapy appointments relative to the TAU arm.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Reasons stated for not initiating behavioral therapy were lack of time, lack of insurance/funding, prioritizing other treatments, and travel plans.

    “Reasons stated for not initiating behavioral therapy were lack of time, lack of insurance/funding, prioritizing other treatments, and travel plans.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the TAU group, themes for not scheduling behavioral therapy were time as a barrier, cost as a barrier, doubt that behavioral therapy would work, difficulty accessing or initiating appointments, satisfaction with current treatment, and prioritizing other things.

    “Themes for why those in the TAU group did not schedule behavioral therapy were: Time as a Barrier, Cost as a Barrier, Does Not Think Behavioral Therapy Will Work, Difficulty Accessing or Initiating appointments, Satisfied with Current Treatment, and Prioritizing Other Things.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Overall, 30.5% (18/59) scheduled and 22.0% (13/59) attended at least one appointment by 3 months after referral to behavioral therapy.

    “Overall across groups, only 18/59 (30.5%) participants scheduled and 13/59 (22.0%) attended at least one appointment by 3 months after their referral to behavioral therapy.”
    • Also stated in: § Discussion: · plain
      “(1) In total across both groups, only 31% participants scheduled and only 22% attended at least one appointment following headache specialist referral to behavioral therapy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Of 76 patients who met criteria and were randomized, 36 were assigned to motivational interviewing and 40 to treatment as usual.

    “Of the 76 patients who met study criteria and were randomized, 36 were assigned MI and 40 were assigned the TAU arm.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The sample was predominantly female, Caucasian, and highly educated, with a mean age of 39±12 years.

    “As seen in more detail in Table 1, subjects were predominantly female, Caucasian and highly educated, with a mean age of 39±12 years.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    All participants had health insurance, and nearly all had prescription drug coverage.

    “All participants had health insurance and almost all had prescription drug coverage.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    19.7% (15/76) had previously participated in any behavioral therapy (CBT, biofeedback, or PMR) within one year before enrollment.

    “About one fifth (15/76; 19.7%) had previously participated in any behavioral therapy (CBT, biofeedback and/or PMR) prior to one year of enrollment into the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    73.3% (55/75) had also seen their primary care physician for headaches.

    “and most had also seen their primary care physician for headaches (55/75; 73.3%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    MI has demonstrated long-term benefits (over one year) in substance abuse.

    “MI is the most successfully disseminated evidence-based practice for substance abuse, with over 80 randomized clinical trials (RCTs) supporting its efficacy, 10 and long-term benefits (>1 year), 11”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] source

  • May combine two claims.

    Study design and conductnone given

    The sample size was large enough and deviations from normality moderate enough to support the use of t-tests.

    “The sample size was large enough and the deviations from normality moderate enough to support the use of t-tests.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A brief telephone intervention of as little as 15 minutes on two occasions effectively motivated participants to attend psychotherapy after MI.

    “One study found that a brief telephone intervention for as little as 15 minutes on two occasions was effective in motivating participants to attend psychotherapy after MI. 14”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    PHQ-8 is an eight-item validated depression scale used as a diagnostic tool and to determine severity of depressive symptoms in the past two weeks.

    “The Patient Health Questionnaire (PHQ-8) is an eight-item validated depression scale used as a diagnostic tool and to determine the severity of depressive symptoms In the past 2 weeks. 20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] source

  • Classified as probably not a substantial claim.

    Premisecitation

    Level of training background does not influence the success of MI.

    “Prior research suggests that the level of training background does not influence the success of MI 24”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    MI counselors were trained with a full-day MINT training, six weeks of one-on-one training, three audio-recorded calls coded with MITI 4.2.1, and coaching.

    “They participated in a full day MI training conducted by a Motivation Interviewing Network of Trainers (MINT) trainer. 26 Then, over approximately six weeks, they received one on one training with a MI instructor from the Health Education and Training Institute (HETI). 27”
    • Also stated in: § Intervention · plain
      “During this time, they completed three individual MI training calls whereby their MI calls were audio-recorded and coded by their individual MI instructor from HETI.”
    • Also stated in: § Intervention · plain
      “via ratings using the Motivational Interviewing Treatment Integrity Code (MITI 4.2.1).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [26]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [27] source
    • cites [28] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Randomization used a block randomization unconcealed list consulted by the study team, created by a statistician unrelated to the study team.

    “Once participants met full study criteria, they were randomized using a block randomization unconcealed list consulted by the study team. The block randomization list was created by a statistician unrelated to the study team.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is little evidence on the minimum length of time needed to have an effective MI intervention.

    “The length of time per call was instructed as guidance only as there is little evidence on the minimum length of time needed to have an effective intervention. 30”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] source

  • Classified as probably not a substantial claim.

    Premisecitation

    MI strategies for pain management include three phases: enhancing, strengthening, and maintaining behavioral changes.

    “This is in line with MI strategies for pain management which includes three phases: enhancing, strengthening and maintaining behavioral changes. 22”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    MIDAS is a validated 5-item questionnaire with internal consistency and test-retest reliability for assessing headache-related disability.

    “The Migraine Disability Assessment (MIDAS) 19 is a validated 5 item questionnaire that has internal consistency and test-retest reliability and was developed to assess headache-related disability with the goal of improving migraine care.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    GAD-7 is a validated, reliable 7-item questionnaire used to screen for general anxiety disorder and measure anxiety symptom severity over the past two weeks.

    “The Generalized Anxiety Disorder 7 (GAD-7) is a validated, reliable 7 item questionnaire used to screen for the presence of general anxiety disorder and to measure anxiety symptom severity over the past 2 weeks. 21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] source

  • Classified as probably not a substantial claim.

    Premisecitation

    Research to find ways to help patients overcome barriers to starting behavioral treatment that reduces opioid use has been prioritized.

    “A need for research focused on engaging patients in ways to overcome barriers to initiating behavioral treatment that has been proven to reduce opioid use has been identified as a priority. 7”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] source

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Different individuals generally made the MI versus TAU calls to avoid contamination between groups.

    “In order to not contaminate the MI group from the TAU group, different individuals generally made the MI versus the TAU calls.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The primary outcome was pre-specified as scheduling a behavioral therapy appointment, but later the outcome was divided into initiation, scheduling, and attending.

    “Initially, when designing the study, we had one pre-specified primary outcome: scheduling the behavioral therapy appointment. Later, after we began the phone calls for this pilot feasibility/acceptability study, we realized that some participants were initiating but not scheduling, others were making the appointment but then not attending the appointment while others were attending the appointment”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Undergraduate students can be trained to successfully deliver MI.

    “and that undergraduate students can be trained to successfully deliver MI. 25”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The planned secondary aim to compare number of behavioral sessions attended could not be completed due to low proportion attending any appointments.

    “A priori, we had planned to also assess and compare the number of behavioral sessions attended. However, given the low proportion of participants attending any appointments, we were unable to complete this secondary aim examining adherence amongst those in treatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The trial was single-blinded, with patients unaware of the full study purpose and their allocation.

    “This was a single blinded study where patients were blinded to the full study purpose and to allocations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Randomization used 1:1 block randomization with blocks of four to six.

    “Using 1:1 block randomization with blocks of 4 to 6, half were randomized to the MI arm (up to 5 MI calls) and the other half were randomized to the treatment as usual (TAU) group”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A meta-analysis showed that MI is effective for people with high levels of distress and for people with low levels of distress.

    “however, a meta-analysis showed that MI is effective for people with high levels of distress and for people with low levels of distress. 24”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premiseown data

    In a prior study on initiation rates for migraine behavioral therapy, 56% initiated making an appointment, and a behavioral therapy clinical trial offered around the same time in the same city provided some patients free cognitive therapy.

    “In our prior study on initiation rates for migraine behavioral therapy, which showed that 56% of people initiated making an appointment, a behavioral therapy clinical trial was being offered around the same time in the same city, thus providing some migraine patients the opportunity to receive some cognitive therapy for free.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The analysis was per protocol, including TAU participants who completed the three-month assessment and MI participants who completed at least one MI call.

    “We utilized a per protocol analysis including only those participants who completed the three month assessment in the TAU group and those who had completed at least one MI call in the active group.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Another study showed that those with higher levels of baseline anxiety had better results with MI.

    “Another study showed that those with higher levels of baseline anxiety had better results with MI 47”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study received NYU Institutional Review Board approval, all subjects gave written informed consent, and the trial was registered on clinicaltrials.gov under NCT03799211.

    “The study was approved by the NYU Institutional Review Board. Written informed consent was obtained from all study subjects. In addition, it was registered on clinicaltrials.gov [NCT03799211].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a prior study of telephone-based MI for medication overuse headache, more calls in the intervention group were associated with fewer headache days at follow-up.

    “In a prior study assessing telephone-based MI for medication overuse headache, more calls in the intervention group were associated with having fewer headache days at follow-up. 15”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] source

  • May combine two claims.

    Interpretationown data

    Brief telephone-based MI may improve rates of initiation of behavioral therapy for migraine, but other barriers appear to lessen the impact on scheduling and attending behavioral therapy appointments.

    “Brief telephone based MI may improve rates of initiation of behavioral therapy for migraine, but other barriers appear to lessen the impact on scheduling and attending behavioral therapy appointments.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The study did not assess stages of change or self-efficacy using in-depth validated psychometric scales; it only assessed importance and confidence rulers.

    “As this was a pragmatic study and we wished to minimize patient burden, we limited the questions asked and did not assess for stages of change or self-efficacy using in-depth validated psychometric scales; we only assessed for importance and confidence rulers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The results support the need to find novel ways to engage and retain patients with migraine in behavioral interventions, as barriers exist even to initial telephone-based motivational interviewing.

    “Our results further support the need to find novel ways to engage and retain patients with migraine in behavioral interventions, as there are barriers even to initial telephone based motivational interviewing that exist.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A systematic review of 72 clinical trials showed a small to medium effect size for improving health outcomes but did not support the theory that increased client change talk predicts behavior change.

    “This is interesting because a systematic review of 72 clinical trials spanning a range of conditions showed a small to medium effect size in improving health outcomes but failed to support the theory that increased client change talk would predict behavior change. 29”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] source

  • May combine two claims.

    Interpretationown data

    MI may help improve rates of initiation of behavioral therapy for migraine, but other barriers appear to lessen the impact on scheduling and attending behavioral therapy appointments.

    “MI may help to improve rates of initiation of behavioral therapy for migraine but other barriers appear to lessen the impact in scheduling and attending the behavioral therapy appointments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The same systematic review found that individuals not seeking treatment benefited the most from MI.

    “They also found that individuals not seeking treatment benefitted the most from MI.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The study might have had different findings-more than 22% attending an initial behavioral therapy session-if conducted in different geographic regions where behavioral therapy is less costly.

    “In addition, we might have had different findings-more than 22% of people referred for behavioral therapy actually attending an initial session of behavioral therapy for migraine, if the study had been conducted in different geographic regions where behavioral therapy is less costly.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study took place in two different types of headache specialist offices: one academic/faculty group practice and one private practice.

    “The study took place in two different types of headache specialist offices (one academic/faculty group practice and one private practice).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Time and cost were themes in both MI and TAU groups and likely account for the discrepancy between initiating behavioral therapy in the MI group and attending the session.

    “Factors such as time and cost were themes across both the MI and TAU groups and likely account for the discrepancy between initiating behavioral therapy in the MI group and attending the session.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Patients may want to engage in behavioral therapy, but external barriers prevent them from doing so.

    “Patients may want to engage in behavioral therapy but for reasons presented in this study (and similar previously published reasons) [see several of the recent reviews on this topic 40,41], there are too many other barriers, oftentimes external factors, preventing them from doing so. 3”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Qualitative MI call data were analyzed with general thematic analysis, using independent coding by two authors, reconciliation of codes, and resolution of discrepancies by a third study member.

    “The final secondary outcome, qualitative MI call data, was evaluated using general thematic analysis.”
    • Also stated in: § Analyses: · plain
      “AG and GS each used the universal code to assign codes to the respondent data, and then reconciled the coding. Discrepancies were resolved by study member MTM.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    In the TAU group, 27 participants were analyzed; 13 could not be reached for the 3-month follow-up call.

    “Similarly, 13 patients from the TAU group could not be reached for their 3-month follow-up call and thus the TAU analysis included n=27 participants.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The intervention was low cost and delivered by non-professionals trained in MI.

    “This was a low cost intervention with non-professionals trained in MI.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The randomization allocation was not fully blinded.

    “Finally, while this was a randomized controlled study, future studies should use a stricter design with the randomization allocation fully blinded.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study included a detailed description of baseline demographic and clinical characteristics.

    “Further, the study included a detailed description of baseline demographic and clinical characteristics.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    One advantage of telephone-based MI over in-person MI is that it may enable some participants with higher barriers to in-person appointments to initially engage.

    “However, one advantage of telephone based MI over in-person MI is that it may enable some participants with higher barriers to in-person appointments to initially engage-using in person MI only reaches those already willing and able come in for a psychological intervention.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior research demonstrated that adding individual MI pretreatment to group CBT for anxiety disorders led to significantly better outcomes than CBT without MI.

    “Also, prior research demonstrated that the addition of individual MI pretreatment (one in-person and 3 telephone based sessions) to group CBT for a heterogeneous group of anxiety disorders led to significantly better outcomes than for CBT without MI. 45”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    MI sessions as short as 15 minutes, used as pre-treatment, improved attendance for mental health treatment and increased uptake of mental health interventions.

    “MI sessions as short as 15 minutes in length, performed as pre-treatment, improved attendance for mental health treatment and thus an increased uptake of mental health interventions. 30”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] source

  • May combine two claims.

    Study design and conductreasoning

    With nonsignificant findings, the study may have type 2 error; a larger sample size might have produced more significant findings.

    “With our nonsignificant findings, we may have type 2 error; if the sample size had been larger we might have had more significant findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The meta-analysis also showed that older participants had greater benefit from MI.

    “The meta-analysis also showed that older participants had greater benefit from MI. 24”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    In the MI group, 32 participants were analyzed; two could not be reached for at least one MI call and two left during the first call before data collection.

    “Two patients could not be reached for at least one MI call, and two others asked to leave the study during the first MI call before any data was obtained; thus, n=32 were analyzed in the MI group.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In two studies, MI pre-treatment facilitated an increase in informal help seeking from parents and significant others.

    “Interestingly, in two of the studies, MI pre-treatment did facilitate an increase in informal help seeking from parents and significant others. 39”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] source

  • May combine two claims.

    Study design and conductown data

    The study anticipated a higher referral rate; only 30% of the overall study population were referred for behavioral therapy.

    “We anticipated having a higher referral rate for behavioral therapy as only 30% of the overall study population were referred for behavioral therapy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    At the time of enrollment in the current study, enrollment in that prior study was closed, potentially increasing cost as a barrier.

    “However, at the time of enrollment in this study, enrollment in that study was closed, potentially increasing cost as a barrier.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The pilot study did not examine headache outcomes comparing MI as a prelude to behavioral therapy versus behavioral therapy alone.

    “However, in this pilot study, we did not examine headache outcomes comparing MI as a prelude to behavioral therapy versus just the behavioral therapy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a pre-treatment of MI before CBT study in GAD, the effects of adding MI pretreatment to CBT on worry reduction appeared greatest for individuals with high worry severity at baseline.

    “For example, in the pre-treatment of MI before CBT study in GAD, the effects of adding an MI pretreatment to CBT on worry reduction appeared to be greatest for individuals with high worry severity at baseline. 46”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study only used telephone-based MI.

    “In addition, we only used telephone-based MI.”
    Quote in the paperNot a substantial claim
82 of 82

  • The paper relies on this without support.

    Studies that did not use a manual reported higher effect scores than those that used one.

    “Prior research has shown that studies that did not use a manual reported higher effect scores than those that used one.”

  • The paper relies on this without support.

    A prior study by the team found that out of 234 eligible patients, about 30% (69/234) were referred for behavioral therapy.

    “A prior study conducted by our team that took place over a similar recruitment period found that out of 234 eligible patients, about 30% (69/234) were referred for behavioral therapy.”

  • The paper relies on this without support.

    The release of a new migraine-specific preventative during the study period led many patients to seek that medication rather than behavioral therapy referral, contributing to the small sample size.

    “However, the study period coincided with the release of a new class of migraine specific preventative medicine to the market. Many patients may have made an appointment with the headache specialist with the specific intention of inquiring about or obtaining the new medication. Thus, we had a small sample size.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Minimum eligible age differs between sections

    Minor

    The abstract allows participants as young as 16, while the Methods section limits eligibility to patients aged 18 or older.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. Campbell J, 2000, Evidence‐Based Guidelines for Migraine Headache: Behavioral and Physical Treatments
  2. National Institutes of Health, HEAL Initiative Research Plan
  3. Jensen MP, 2002, Psychological Approaches to Pain Management, Second Edition: A Practitioner's Handbook, 71
  4. Yung A, 2017, A novel model to support lifestyle interventions in cancer survivors: Undergraduate students and multimodal software platform, Society for Behavioral Medicine Annual Meeting
  5. MINT, 2018, Motivational Interview Training
  6. Health Education and Training Institute, MITI Coding Services
  7. 10.1093/pm/pny028 · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Minen, M. T., Sahyoun, G., Gopal, A., Levitan, V., Pirraglia, E., Simon, N. M., & Halpern, A.
Affiliations
  • NYU Langone Health (US)
  • Columbia University (US)
  • City College of New York (US)
Corresponding author
Minen, Mia T.
ORCID
Venue
Headache The Journal of Head and Face Pain
Publisher
Wiley
Published
2020-01-24
Volume
60
Issue
2
Pages
441-456
ISSN
  • 0017-8748 (ISSN-L)
  • 1526-4610
DOI
10.1111/head.13738
PMC
PMC7754247
OpenAlex
W3001785291
Semantic Scholar
27fb70282270d4bad3c2f85cb648c047ddb04f93
Cited by
12
References
42
Citations by year
2026: 1 · 2025: 1 · 2024: 3 · 2022: 1 · 2021: 4 · 2020: 2
FWCI
1.27
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Headache The Journal of Head and Face Pain (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Center for Complementary and Integrative Health (K23 AT009706)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
Keywords
motivational interviewing, migraine, behavior therapy, treatment initiation, telephone counseling, appointment scheduling, appointment attendance, barriers to care, cognitive behavioral therapy, biofeedback, relaxation training, headache prevention, ambivalence
MeSH terms
Adolescent, Adult, Aged, Behavior Therapy, Female, Follow-Up Studies, Health Services Accessibility, Humans, Male, Middle Aged, Migraine Disorders, Patient Acceptance of Health Care, Patient Compliance, Pilot Projects, Telephone, Single-Blind Method, Outcome Assessment, Health Care, Telemedicine, Young Adult, Motivational Interviewing

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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