Cognitive-Behavioral Therapy for Insomnia to Reduce Chronic Migraine: A Sequential Bayesian Analysis

被引:40
作者
Smitherman, Todd A. [1 ]
Kuka, Alexander J. [1 ]
Calhoun, Anne H. [2 ]
Walters, A. Brooke Pellegrino [3 ]
Davis-Martin, Rachel E. [4 ]
Ambrose, Carrie E. [5 ]
Rains, Jeanetta C. [6 ]
Houle, Timothy T. [7 ]
机构
[1] Univ Mississippi, Migraine & Behav Hlth Lab, Dept Psychol, Oxford, MS USA
[2] Carolina Headache Inst, Durham, NC USA
[3] Hartford Healthcare Headache Ctr, Hartford, CT USA
[4] Univ Massachusetts, Sch Med, Dept Emergency Med, Worcester, MA USA
[5] Lake City VA Med Ctr, Lake City, FL USA
[6] Elliot Hosp, Ctr Sleep Evaluat, Manchester, NH USA
[7] Massachusetts Gen Hosp, Dept Anesthesia Crit Care & Pain Med, Boston, MA 02114 USA
来源
HEADACHE | 2018年 / 58卷 / 07期
关键词
chronic migraine; insomnia; CBTi; Bayesian statistics; sleep restriction; stimulus control; RANDOMIZED CONTROLLED-TRIAL; COMORBID INSOMNIA; PSYCHIATRIC COMORBIDITY; SLEEP HYGIENE; PRIMARY-CARE; HEADACHE; METAANALYSIS; MANAGEMENT; ADOLESCENTS; DISABILITY;
D O I
10.1111/head.13313
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BackgroundInsomnia is frequently comorbid with chronic migraine, and small trials suggest that cognitive-behavioral treatment of insomnia (CBTi) may reduce migraine frequency. This study endeavored to provide a quantitative synthesis of existing CBTi trials for adults with chronic migraine using Bayesian statistical methods, given their utility in combining prior knowledge with sequentially gathered data. MethodsCompleter analyses of 2 randomized trials comparing CBTi to a sham control intervention (Calhoun and Ford, 2007; Smitherman et al, 2016) were used to quantify the effects of a brief course of treatment on headache frequency. Change in headache frequency from baseline to the primary endpoint (6-8 weeks posttreatment) was regressed on group status using a Gaussian linear model with each study specified in the order of completion. To estimate the combined effect, posterior distributions from the Calhoun and Ford study were used as informative priors for conditioning on the Smitherman et al data. ResultsIn a combined analysis of these prior studies, monthly headache frequency of the treatment group decreased by 6.2 days (95%CrI: -9.7 to -2.7) more than the control group, supporting an interpretation that there is a 97.5% chance that the treatment intervention is at least 2.7 days better than the control intervention. The analysis supports the hypothesis that at least for those who complete treatment, there is high probability that individuals who receive CBTi experience greater headache reduction than those who receive a control intervention equated for therapist time and out-of-session skills practice. ConclusionCognitive-behavioral interventions for comorbid insomnia hold promise for reducing headache frequency among those with chronic migraine. These findings add to a small but growing body of literature that migraineurs with comorbid conditions often respond well to behavioral interventions, and that targeting comorbidities may improve migraine itself.
引用
收藏
页码:1052 / 1059
页数:8
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