Ng Qin Xiang, Venkatanarayanan Nandini, Kumar Lakshmi
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Queen's Medical Centre, University of Nottingham Medical School, Nottingham, United Kingdom.
Headache. 2017 Mar;57(3):349-362. doi: 10.1111/head.13016. Epub 2016 Dec 28.
Migraine headaches are common in children and adolescents. Current pharmacologic treatment options are limited despite the prevalence and debilitating effects of pediatric migraine. Cognitive behavioral therapy (CBT) is an evidence-based practice that focuses on the development of coping strategies and cognitive restructuring to alter the pain experience. Till date, no meta-analysis has been done to examine the use of CBT in pediatric migraine.
Using the keywords (cognitive behavioral therapy OR cognitive behavior therapy OR cognitive behavioral therapy OR cognitive behavior therapy OR CBT) AND (headache OR migraine), a preliminary search on the PubMed and Ovid database yielded 3841 articles published in English between 1 Jan 1980 and 1 May 2016. Full articles were also reviewed for references of interest. After data extraction, 14 studies were included in the meta-analysis.
The results of the meta-analysis well-support the clinical role of CBT in the management of pediatric migraine. The pooled odds ratios of clinically significant improvement, that is, 50% or greater headache activity reduction post-treatment and at follow-up (3 months or later) were OR 9.11 (95% CI: 5.01 to 16.58, P < .001) and OR 9.18 (95% CI: 5.69 to 14.81, P < .001) respectively, demonstrating significant clinical improvement with CBT as compared with wait-list control, placebo, or standard medication. Furthermore, the clinical improvement was stable, even at a 1-year follow-up as evident in some of the studies.
There is good evidence that CBT is beneficial to children suffering from migraine, and may also augment the efficacy of standard medications such as amitriptyline.
偏头痛在儿童和青少年中很常见。尽管儿童偏头痛患病率高且有使人衰弱的影响，但目前的药物治疗选择有限。认知行为疗法（CBT）是一种基于证据的疗法，专注于制定应对策略和认知重构以改变疼痛体验。迄今为止，尚未进行荟萃分析来研究CBT在儿童偏头痛中的应用。
使用关键词（认知行为疗法或认知行为治疗或CBT）和（头痛或偏头痛），在PubMed和Ovid数据库上进行初步检索，得到1980年1月1日至2016年5月1日期间以英文发表的3841篇文章。还对全文进行了审查以获取感兴趣的参考文献。数据提取后，14项研究被纳入荟萃分析。
荟萃分析结果有力支持了CBT在儿童偏头痛管理中的临床作用。临床显著改善的合并比值比，即治疗后及随访（3个月或更晚）时头痛活动减少50%或更多，分别为OR 9.11（95%CI：5.01至16.58，P＜0.001）和OR 9.18（95%CI：5.69至14.81，P＜0.001），表明与等待名单对照、安慰剂或标准药物相比，CBT有显著的临床改善。此外，如一些研究所示，即使在1年随访时临床改善也是稳定的。
有充分证据表明CBT对偏头痛儿童有益，并且可能还会增强如阿米替林等标准药物的疗效。
