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Behav Res Ther. 2014 Oct;61:1-11. doi: 10.1016/j.brat.2014.07.002. Epub 2014 Jul 16.

Behavioral management of the triggers of recurrent headache: a randomized controlled trial.

Author information

School of Applied Psychology, Behavioural Basis of Health Research Centre, Griffith University, Mt Gravatt Campus, 176 Messines Ridge Road, Mt Gravatt, Queensland 4122, Australia. Electronic address:
School of Health Sciences, RMIT University, PO Box 71, Bundoora, Victoria 3083, Australia; Australian College of Applied Psychology, Australia.
School of Psychology and Psychiatry, Monash University, Monash Medical Centre, 246 Clayton Road, Victoria 3168, Australia.
School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
Headache Group, NIHR-Welcome Trust Clinical Research Facility, King's College London, UK.


This study was designed to evaluate the traditional advice to headache sufferers to avoid all triggers ('Avoidance'), and a novel approach to trigger management (Learning to Cope with Triggers - 'LCT') that included graduated exposure to selected triggers to promote desensitization. Individuals (84F, 43M) with migraine and/or tension-type headache were assigned randomly to one of four groups: Waiting-list (Waitlist); Avoidance; Avoidance combined with cognitive behavior therapy (Avoid + CBT); and LCT. Changes in headaches and medication consumption (in parentheses) from pre- to post-treatment were (a minus sign indicates improvement): Waitlist, +11.0% (+15.4%); Avoidance, -13.2% (-9.0%); Avoid + CBT, -30.0% (-19.4%); and LCT, -35.9% (-27.9%). Avoidance did not differ significantly from Waitlist on headaches or medication use, but LCT differed significantly from Waitlist on both measures. Avoid + CBT significantly differed from Waitlist on headaches but not medication consumption. In summary, the study failed to find support for the standard approach to trigger management of advising avoidance, but LCT emerged as a promising strategy. LCT resulted in greater improvement than the other three conditions on all measures of headaches and medication consumption, and was the only treatment condition that significantly differed from the waiting-list control condition in terms of treatment responder rate (50% or greater reduction in headaches) and medication consumption.


Coping; Desensitization; Migraine; Tension-type headache; Triggers

[Indexed for MEDLINE]

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