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).

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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.

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“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].”

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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