• Ashley M Kroon Van Diest, Rachelle R Ramsey, Susmita Kashikar-Zuck, Shalonda Slater, Kevin Hommel, John W Kroner, Susan LeCates, Marielle A Kabbouche, Hope L O'Brien, Joanne Kacperski, Janelle R Allen, James Peugh, Andrew D Hershey, and Scott W Powers.
• Divisions of *Behavioral Medicine and Clinical Psychology §Neurology ‡Headache Center, Cincinnati Children's Hospital Medical Center †Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
• Clin J Pain. 2017 Oct 1; 33 (10): 892898892-898.

ObjectivesTo examine treatment adherence among children and adolescents with chronic migraine who volunteered to be in a clinical trial using 3 measures: treatment session attendance, therapy homework completion, and preventive medication use by daily diary.Materials And MethodsAnalyses are secondary from a trial of 135 youth aged 10 to 17 years diagnosed with chronic migraine and with a Pediatric Migraine Disability Score over 20. Participants were randomly assigned to cognitive-behavioral therapy plus amitriptyline (CBT+A, N=64) or headache education plus amitriptyline (HE+A, N=71). Therapists recorded session attendance. Completion of homework/practice between sessions was reported to therapists by patients. Patients reported preventive medication adherence using a daily headache diary.ResultsMean session attendance adherence out of 10 treatment sessions was 95% for CBT+A and 99% for HE+A. CBT+A participants reported completing a mean of 90% of home practice of CBT skills between the 10 sessions. Participants reported taking amitriptyline daily at a mean level of 90% when missing diaries were excluded and 79% when missing diaries were considered as missed doses of medication.DiscussionOur findings demonstrate that youth with chronic migraine who agree to be a part of a clinical trial do quite well at attending therapy sessions, and report that they are adherent to completing home/practice between sessions and taking medication. These results lend further support to consideration of CBT+A as a first-line treatment for youth with chronic migraine and suggest that measurement of adherence when this treatment is provided in practice will be important.

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