Treatment of chronic migraine and insomnia with cognitive behavioral therapy

Introduction. Chronic migraine (CM) is a neurological disease which is often comorbid with chronic insomnia (CI). The interdisciplinary approach including the cognitive behavioural therapy (CBT) is recommended for the treatment of patients with CM and comorbid CI.

Aim. To evaluate the effectiveness of the interdisciplinary treatment program including CBT in the treatment of patients with CM and CI. Materials and methods. A total of 54 patients with CM and CI (19 men and 35 women, mean age 34.1 ± 8.5 years), were enrolled in the study. The clinical and psychological characteristics were assessed before and after treatment (at Month 3, 6, 12) using interviewing, testing, headache and sleep diaries. All patients received the interdisciplinary treatment, including pharmacotherapy, discontinuation of pain medications in the presence of drug-induced headache (DIHA), CBT for headache and insomnia.

Results. Three months after treatment, there was a statistically significant decrease in mean scores for headache frequency, pain drugs dosing interval, insomnia severity index, as well as according to the Spielberger Khanin's Reactive and Personal Anxiety Scale, Beck Depression Scale, Impact of Migraine on Daily Activities Scale (p < 0.05). The achieved improvements were maintained at Months 6 and 12 of the follow-up period. At Month 3, 35 (65%) patients achieved a clinical effect in the treatment of CM: the frequency of headache decreased by 50% or more, 41 (76%) patients achieved a clinical effect in the treatment of CI: the insomnia severity index decreased by 8 scores and more. At Month 6, 42 (77.8%) patients had a clinical effect in CM therapy, and 44 (81.5%) patients in CI therapy. The achieved clinical effects have been shown to be maintained by Month 12 of the follow-up period.

Conclusion. The interdisciplinary program including CBT is effective in the treatment of patients with CM and CI over the shortand long-term horizon.

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