Acceptansbaserad kognitiv beteendeterapi via internet för frekvent migrän i primärvården:utveckling och utvärdering av en komplex intervention

Abstract

Background: Migraine is an episodic neurological disorder affecting 14% of the population, which can develop into chronic migraine, leading to significant suffering and disability. Standard treatment in primary care is primarily pharmacological, while psychological interventions that can enhance patients' pain management and quality of life are relatively underdeveloped. Objective: The overall aim of this doctoral project was to develop and evaluate an acceptance-based cognitive-behavioral therapy (CBT) intervention delivered via internet, called I AM (Internet Approach to Migraine), for individuals with frequent migraine within primary care. The intervention was developed through successive phases following the Medical Research Council (MRC) framework. Results: During the development phase, two qualitative interview studies (Studies I and II) were conducted to deepen understanding of pain experiences and pain management in episodic and chronic migraine. Study I identified dilemmas related to when and how to relieve pain in chronic migraine. Study II highlighted the complexity of the pain experience, common reactions, and behaviors during a migraine attack. These findings, along with current research on pain treatment, risk factors and evidence-based methods in CBT, formed the basis for the development of I AM. In the feasibility phase, a randomized controlled pilot study (RCT) with a mixed-methods design (Study III) demonstrated good feasibility of I AM in primary care, with patients perceiving it as an important and meaningful complement to medical treatment. The effectiveness phase evaluated the clinical effects of I AM in a larger RCT involving 154 participants with episodic and chronic migraine from the Västra Götaland region in Sweden (Study IV). A subsequent follow up study of the RCT with a mixed-methods design examined the long-termeffects of I AM (Study V). At 12 months follow up the study showed significant between-group differences in pain intensity (0.7; p=0.043), disease burden (3.9; p=0.001), and mental health and well-being (5.1; p=0.023), favoring the I AM group over Treatment as usual (TAU). Conclusion: I AM, as a supplement to standard medical care, appears to promote long-term psychological and functional improvements in individuals with frequent or chronic migraine. These findings suggest that acceptance-based CBT has potential as part of stepped and integrated care models for migraine management in primary care.