In patients with comorbid insomnia and chronic migraine, a cognitive behavioral treatment (CBT) for insomnia may reduce headache frequency effectively, according to a study published in Headache.
For this study, investigators analyzed 2 randomized trials that enrolled individuals who reported ≥15 headache days/month. Participants in the both trials were randomly assigned to receive a CBT intervention for insomnia (n=23 and n=16, respectively) or a sham intervention (n=20 and n=15, respectively).
In the first trial, the program consisted of a single intervention during which sleep hygiene education and relaxation/visualization techniques were provided, and in the second trial, the program involved 3 sessions focused on sleep restriction (ie, restricting bed time to total sleep time plus 30 minutes).
Sham control in both studies included education on lifestyle behaviors not related to headache activity. Reduction in monthly headache frequency 6 to 8 weeks after treatment was the primary outcome in both trials.
In both studies, participants who received CBT for insomnia reported a greater reduction in headache frequency than those who received the sham treatment (7.9-day difference; 95% CI, 212.4-23.4; 3.1-day difference, respectively; pooled analysis: 6.2-day difference; 95% CI, 29.7-22.7).
Limitations of the analysis include the small sample size in both studies as well as the lack of long-term follow-up.
“CBT [for insomnia] thus may offer promise as an adjunctive chronic migraine intervention within medical practice settings via individual, group, or electronic administration, pending larger studies of its efficacy [in patients with chronic migraine].”
Smitherman TA, Kuka AJ, Calhoun AH, et al. Cognitive-behavioral therapy for Insomnia to reduce chronic migraine: a sequential Bayesian analysis [published online May 6, 2018]. Headache. doi: 10.1111/head.13313