Predictors of the effectiveness of comprehensive personalised treatment of chronic migraine using cognitive behavioural therapy

When dealing with chronic migraine (CM), it's worth trying a comprehensive personalised treatment that includes cognitive behavioural therapy (CBT) and therapy for comorbid disorders.

Objective: to identify predictors of the effectiveness of comprehensive personalised treatment, including CBT, in patients with CM.

Material and methods. The study included 100 patients with CM (30 men, 70 women; mean age 34.5±7.4 years). All patients received comprehensive personalised treatment, including CBT, migraine pharmacotherapy, lifestyle recommendations, therapeutic exercises and recommendations for physical activity (in the presence of musculoskeletal pain of other localisation), detoxification therapy (in the presence of druginduced headache), and sleep hygiene (in cases of insomnia). Clinical and psychological indicators were assessed before treatment and at 3, 6, 12, and 18 months of follow-up.

Results. At month 3, statistically significant (p<0.05) improvements were achieved: reduction in headache frequency, frequency and number of pain medication (PM) doses, dependence on PM, impact of migraine on daily activities, pain catastrophising, anxiety, depression, severity of insomnia, intensity of pain in other locations, and increased adherence to treatment according to the quantitative assessment of adherence to treatment scale (QAA-25). From the 6th to the 18th month of observation, the trend of improvement in the above indicators continued. Clinical effect (CE) in relation to CM was achieved by 74% of patients at 3 months and 79% at 6 months, and this indicator remained stable at 12 and 18 months of observation. A statistically significant association was established using binary logistic regression at the 3rd and 6th–18th months of observation between CE in relation to CM and the duration of CM up to 24 months, with initial adherence to treatment ≥56% according to QAA-25.

Conclusion. Predictors of the effectiveness of comprehensive personalised treatment, including CBT, are a duration of CM up to 24 months and initial adherence to treatment ≥56% according to QAA-25.

1. Kung D, Rodriguez G, Evans R. Chronic Migraine: Diagnosis and Management. Neurol Clin. 2023 Feb;41(1):141-59. doi: 10.1016/j.ncl.2022.05.005

2. Steiner TJ, Birbeck GL, Jensen RH, et al. Headache disorders are third cause of disability worldwide. J Headache Pain. 2015;16:58. doi: 10.1186/s10194-015-0544-2

3. The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38(1):1-211. doi: 10.1177/0333102417738202

4. Ayzenberg I, Katsarava Z, Sborowski A, et al; Lifting the Burden. The prevalence of primary headache disorders in Russia: a countrywide survey. Cephalalgia. 2012;32(5):373-81. doi: 10.1177/0333102412438977

5. Torres-Ferrus M, Ursitti F, Alpuente A, et al; School of Advanced Studies of European Headache Federation (EHF-SAS). From transformation to chronification of migraine: pathophysiological and clinical aspects. J Headache Pain. 2020;21(1):42. doi: 10.1186/s10194-020-01111-8

6. Buse DC, Greisman JD, Baigi K, Lipton RB. Migraine Progression: A Systematic Review. Headache. 2019;59(3):306-38. doi: 10.1111/head.13459

7. Burch RC, Buse DC, Lipton RB. Migraine: Epidemiology, Burden, and Comorbidity. Neurol Clin. 2019 Nov;37(4):631-49. doi: 10.1016/j.ncl.2019.06.001

8. Giri S, Tronvik E, Linde M, et al. Randomized controlled studies evaluating Topiramate, Botulinum toxin type A, and mABs targeting CGRP in patients with chronic migraine and medication overuse headache: A systematic review and meta-analysis. Cephalalgia. 2023;43(4):3331024231156922. doi: 10.1177/03331024231156922

9. Kniazeva IA, Gilev DV, Osipova VV, Lebedeva ER. Demographic and comorbid factors associated with the development of medication overuse headache. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(1S):12-8. doi: 10.14412/2074-2711-2024-1S-12-18 (In Russ.).

10. Golovacheva VA, Golovacheva AA, Tarshilova AR, Osipova VV. Diagnosis of chronic migraine and comorbid neurological disorders in real-life clinical practice. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(1S):23-30. doi: 10.14412/2074-2711-2024-1S-23-30 (In Russ.).

11. Golovacheva VA, Golovacheva AA, Romanov DV, Volodarskaya EA. Mental disorders, social and demographic characteristics of patients with chronic and episodic migraine. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry. 2024;124(1):94-101. doi: 10.17116/jnevro202412401194 (In Russ.).

12. Filatova EG, Osipova VV, Tabeeva GR, et al. Diagnosis and treatment of migraine: Russian experts' recommendations. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(4):4-14. doi: 10.14412/2074-2711-2020-4-4-14 (In Russ.).

13. Golovacheva VA, Golovacheva AA, Tarshilova AR, Osipova VV. Typical clinical practice of treating patients with chronic migraine. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(1S):31-7. doi: 10.14412/2074-2711-2024-1S-31-37 (In Russ.).

14. Tabeeva GR, Filatova EG, Amelin AV, et al. Alternative and complementary treatments for migraine. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(1):4-15. doi: 10.14412/2074-2711-2024-1-4-15 (In Russ.).

15. Golovacheva VA, Golovacheva AA, Fateeva TG, Parfenov VA. Cognitive behavioral therapy in the treatment of patients with chronic migraine and concomitant chronic insomnia: a prospective, randomized trial. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry. 2024;124(5-2):110-7. doi: 10.17116/jnevro2024124052110 (In Russ.).

16. Golovacheva VA. Interdisciplinary treatment including cognitive behavioral therapy and mindfulness for chronic migraine and druginduced headache. Meditsinskiy sovet = Medical Council. 2023;(10):80-8. doi: 10.21518/ms2023216 (In Russ.).

17. Golovacheva VA, Golovacheva AA, Parfenov VA. Optimizing the management of patients with chronic migraine and neck pain: a prospective randomized trial with longterm follow-up. Russian Neurological Journal. 2024;29(6):35-43. doi: 10.30629/2658-7947-2024-29-6-35-43 (In Russ.).

18. Golovacheva VA, Golovacheva AA. Efficacy of cognitive behavioral therapy in chronic migraine and medication overuse headache: a prospective randomized trial. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(6):21-7. doi: 10.14412/2074-2711-2024-6-21-27 (In Russ.).

19. Modarresi S, Lukacs MJ, Ghodrati M, et al; CATWAD Consortium Group. A Systematic Review and Synthesis of Psychometric Properties of the Numeric Pain Rating Scale and the Visual Analog Scale for Use in People With Neck Pain. Clin J Pain. 2021 Oct 26;38(2):132-48. doi: 10.1097/AJP.0000000000000999

20. Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res (Hoboken). 2011;63 Suppl 11(0 11):S467-S472. doi: 10.1002/acr.20561

21. Henry SK, Grant MM, Cropsey KL. Determining the optimal clinical cutoff on the CES-D for depression in a community corrections sample. J Affect Disord. 2018 Jul;234:270-5. doi: 10.1016/j.jad.2018.02.071

22. Ikemoto T, Hayashi K, Shiro Y, et al. A systematic review of cross-cultural validation of the pain catastrophizing scale. Eur J Pain. 2020;24(7):1228-41. doi: 10.1002/ejp.1587

23. Stewart WF, Lipton RB, Dowson AJ, Sawyer J. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headacherelated disability. Neurology. 2001;56(6 Suppl 1):S20-S28. doi: 10.1212/wnl.56.suppl_1.s20

24. Wang YF, Tzeng YS, Yu CC, et al. Clinical Utility of Leeds Dependence Questionnaire in Medication-Overuse Headache. Diagnostics (Basel). 2023;13(3):472. doi: 10.3390/diagnostics13030472

25. Morin CM, Belleville G, Belanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011 May 1;34(5):601-8. doi: 10.1093/sleep/34.5.601

26. Nikolaev NA, Skirdenko YuP. Russian generic questionnaire for evaluation of compliance to drug therapy. Klinicheskaya farmakologiya i terapiya. 2018; 27(1):74-8. Available at: https://clinpharm-journal.ru/articles/2018-1/rossijskij-universalnyj-oprosnik-kolichestvennoj-otsenki-priverzhennosti-k-lecheniyu-kop25/ (In Russ.).

27. Tabeeva GR, Osipova VV, Filatova EG, et al. Evaluation and treatment of medication-overuse headache: Russian experts’ guidelines. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2022;14(1):4-13. doi: 10.14412/2074-2711-2022-1-4-13 (In Russ.).

28. Bae JY, Sung HK, Kwon NY, et al. Cognitive Behavioral Therapy for Migraine Headache: A Systematic Review and MetaAnalysis. Medicina (Kaunas). 2021 Dec 28;58(1):44. doi: 10.3390/medicina58010044

29. Parfenov VA, Yakhno NN, Davydov OS, et al. Chronic nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2S):7-16. doi: 10.14412/2074-2711-2019-2S-7-16 (In Russ.).

30. Parfenov VA, Yakhno NN, Kukushkin ML, et al. Non-specific neck pain (cervicalgia). Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2023;15(5):4-12. doi: 10.14412/2074-27112023-5-4-12 (In Russ.).

31. Parfenov VA, Golovacheva VA, Isaikin AI, et al. Treatment of chronic non-specific (musculoskeletal) back pain. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(3S):1-16. doi: 10.14412/2074-2711-2024-3S-1-16 (In Russ.).

32. Golovacheva VA, Tabeeva GR, Golovacheva AA. Non-specific low back pain: principles and algorithms for successful management of patients in real clinical practice. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2023;15(3):85-94. doi: 10.14412/2074-2711-2023-3-85-94 (In Russ.).

33. Golovacheva AA, Golovacheva VA. Complex treatment of patients with chronic non-specific back pain and comorbid disorders: a prospective clinical study. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2024;16(6):45-52. doi: 10.14412/2074-2711-2024-6-45-52 (In Russ.).

34. Beck AT. A 60-Year Evolution of Cognitive Theory and Therapy. Perspect Psychol Sci. 2019;14(1):16-20. doi: 10.1177/1745691618804187

35. Ornello R, Baldini F, Onofri A, et al. Impact of duration of chronic migraine on long-term effectiveness of monoclonal antibodies targeting the calcitonin gene-related peptide pathway – A real-world study. Headache. 2025 Jan;65(1):61-7. doi: 10.1111/head.14788

36. Kovalchuk NA, Kiryanova EA, Tabeeva GR. Medication adherence in migraine patients (data of an online survey). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2021;13(4):81-7. doi: 10.14412/2074-2711-2021-4-81-87 (In Russ.).

37. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a selfreported measure of medication adherence. Med Care. 1986 Jan;24(1):67-74. doi: 10.1097/00005650-198601000-00007

38. Onur OS, Ertem DH, Karsidag C, et al. An open/pilot trial of cognitive behavioral therapy in Turkish patients with refractory chronic migraine. Cogn Neurodyn. 2019;13(2):183-9. doi: 10.1007/s11571-019-09519-y

39. Treadwell JR, Tsou AY, Rouse B, et al. Behavioral interventions for migraine prevention: A systematic review and meta-analysis. Headache. 2025 Apr;65(4):668-94. doi: 10.1111/head.14914