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Headache. 2018 Nov;58(10):1556-1567. doi: 10.1111/head.13389. Epub 2018 Aug 23.

Longitudinal Analysis of Patient-Reported Outcomes From an Interdisciplinary Pediatric Pain Rehabilitation Program for Children With Chronic Migraine and Headache.

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Cleveland Clinic - Pediatric Behavioral Health, Cleveland, OH, USA.
Cleveland Clinic Children's Hospital - Quantitative Health Sciences, Cleveland, OH, USA.



Many 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.


This 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.


A 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.


One 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).


Children 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.


adolescents; children; chronic headache; chronic migraine; rehabilitation


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