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Telemedicine-based cognitive behavioral therapy (TENACITY) for Veterans with chronic migraine: A pilot randomized
Teresa M Damush1,2,3,4, Samantha M Calcatera1,2, Olivia Datre1,2
1Veterans Health Administration (VHA) Headache Centers of Excellence Research, Evaluation, Education, Engagement Centers of Headache (RE3ACH), West Haven, CT, USA.
Cephalalgia Reports
|June 10, 2026
Summary
Telehealth cognitive behavioral therapy for headache (CBT-HA) is feasible and accessible. This pilot trial compared CBT-HA delivered via telehealth to usual care, finding it a viable option for headache patients.
Area of Science:
- Neurology
- Behavioral Medicine
- Health Services Research
Background:
- Behavioral interventions show clinical efficacy for headache (HA) but lack accessibility.
- Clinic-based treatments are often out of reach for many HA patients.
- Telehealth offers a potential solution to improve access to behavioral therapies.
Purpose of the Study:
- To pilot a randomized controlled trial assessing the feasibility of telehealth-delivered cognitive behavioral therapy for headache (CBT-HA).
- To compare CBT-HA delivered via telehealth (TENACITY) against enhanced usual care (EHUT).
Main Methods:
- A single-blinded, randomized controlled pilot trial (TENACITY) was conducted across multiple sites.
- Participants underwent a 31-day screening for chronic migraine followed by a 12-week CBT-HA treatment period.
- Follow-up assessments occurred at 3 and 6 months post-treatment initiation.
Main Results:
- The primary outcome is the change in self-reported headache days from baseline to 3 months post-treatment.
- Secondary outcomes will also be analyzed at 3- and 6-month follow-ups.
- Analysis will utilize a generalized mixed effects model for intention-to-treat.
Conclusions:
- Telehealth delivery of CBT-HA (TENACITY) presents a feasible approach to increase treatment accessibility.
- This pilot study provides a foundation for larger trials investigating telehealth interventions for headache disorders.
- The findings support the potential of digital health solutions in managing chronic headache conditions.
