Cognitive therapy vs. self-management training in the treatment of chronic headaches

In view of the association between chronic headaches and depression, this study compared a cognitive therapy package designed for depression with a relatively standard behavioural treatment package designed for headaches (self-management training), in terms of their effects on headaches and depressive symptoms. Fifty-five subjects suffering from chronic headaches (tension, migraine and combined) were randomly assigned to the two treatment conditions. Cognitive therapy and self-management training were equally effective at decreasing headaches and depressive symptoms on most measures. Changes in headaches and depressive symptoms were not significantly correlated in either condition, however. Greater headache improvement was associated with high pre-treatment headache activity for both conditions but, whilst self-management training was more effective for subjects low on depression, cognitive therapy was more effective for subjects high on chronicity. This suggests that the latter approach, or some variation of it, may be the treatment of choice for more chronic headache sufferers with depressive symptoms.