• Ethan Benore, Erin E Webster, Lu Wang, and Gerard Banez.
• Cleveland Clinic - Pediatric Behavioral Health, Cleveland, OH, USA.
• Headache. 2018 Nov 1; 58 (10): 1556-1567.

BackgroundMany children suffering from chronic headache and migraine present with comorbid functional disability, including physical, social, emotional, and academic activities. For children severely impaired by headache, intensive interdisciplinary pain rehabilitation treatment (IIPT) can improve functioning. However, there are limited data evaluating children's response to rehabilitation across several time points.ObjectiveThis study aims to evaluate the trajectory of recovery for children undergoing IIPT for chronic headache, as well as to examine the proposed assumption that physical and psychosocial functioning improves prior to a reported reduction in pain.MethodsA retrospective analysis of patient-reported outcomes in a clinical database of 135 children admitted to an IIPT program between the years 2008 and 2014 was analyzed. Available data across 5 separate time points (up to 1-year post-discharge) were reviewed.ResultsOne hundred and thirty-five children of mean age 15.2 (SD = 2.2) and 74% female provided data for review. Linear mixed model demonstrated a statistically significant improvement in pain-specific measures of functioning, including daily functioning (change estimate = -14.53) emotional functioning (change estimate = -14.63), family functioning (change estimate = -5.78), and school absences (change estimate = -11.47) over a 12-month period (all P's ≤ .01). A more general measure of quality of life improved during the program, based upon child (change estimate = +10.07) and parent report (change estimate = +15.31); although these gains did not continue to improve post-discharge. As expected, although children did not report a reduction in pain during rehabilitation (change estimate = +0.07), they did report a significant drop in perceived pain in the 12 months following discharge from the program (change estimate = -2.12, P ≤ .01).ConclusionsChildren with chronic headache and migraine who are severely functionally impaired demonstrated linear improvement in pain-specific patient-reported outcomes over time; however, there remains a need for improved methodology in analyzing response to IIPT programs.© 2018 American Headache Society.

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