Crawford Megan R, Luik Annemarie I, Espie Colin A, Taylor Hannah L, Burgess Helen J, Jones Alex L, Ong Jason C
School of Psychological Science and Health, University of Strathclyde, Glasgow, UK.
Psychology Department, Swansea University, Glasgow, UK.
Headache. 2020 May;60(5):902-915. doi: 10.1111/head.13777. Epub 2020 Feb 28.
OBJECTIVE/BACKGROUND: Insomnia commonly co-occurs with chronic migraines (CM). Non-pharmacological treatments for insomnia in CM patients remain understudied. This is a proof-of-concept study, which aims to evaluate the feasibility, acceptability, and preliminary efficacy of a digital cognitive behavioral therapy for insomnia (dCBT-I) for individuals with CM and insomnia (CM-I) in the United States.
We recruited 42 females with CM-I symptoms from a U.S.-based observational cohort and from the general population via advertisements. Within a multiple baseline design, participants were randomized to receive dCBT-I after 2, 4, or 6 weeks of completing baseline sleep diaries. DCBT-I was scrutinized against benchmarks for completion rates (≥90% to complete dCBT-I), acceptability (≥80% to find dCBT-I acceptable), and posttreatment changes in insomnia symptoms (≥50% indicating a clinically relevant improvement in their insomnia symptoms). As a secondary measure, we also reported percentage of individuals reverting to episodic migraines.
Out of 42 randomized, 35 (83.3%) completed dCBT-I within the 12 weeks provided. Of these completers, 33 (94.3%) reported being satisfied (n = 16) or very satisfied (n = 17) with treatment. Additionally, 65.7% of completers responded to treatment as per universally accepted criteria for insomnia. Lastly, 34% of completers reverted from CM to episodic migraine.
This study provides evidence for the feasibility and acceptability of dCBT-I in patients with CM-I complaints. Effects of improving insomnia and migraines were suggested. These results indicate that a randomized controlled trial is needed to determine the efficacy of dCBT-I in CM patients.
目的/背景：失眠常与慢性偏头痛（CM）同时出现。针对CM患者失眠的非药物治疗仍未得到充分研究。这是一项概念验证研究，旨在评估针对美国患有CM和失眠（CM-I）的个体的数字认知行为疗法治疗失眠（dCBT-I）的可行性、可接受性和初步疗效。
我们通过广告从美国的一个观察性队列和普通人群中招募了42名有CM-I症状的女性。在多基线设计中，参与者在完成基线睡眠日记2、4或6周后被随机分配接受dCBT-I。根据完成率（≥90%完成dCBT-I）、可接受性（≥80%认为dCBT-I可接受）以及治疗后失眠症状的变化（≥50%表明其失眠症状有临床相关改善）对dCBT-I进行评估。作为次要指标，我们还报告了恢复为发作性偏头痛的个体百分比。
在42名随机分组的参与者中，35名（83.3%）在提供的12周内完成了dCBT-I。在这些完成治疗的参与者中，33名（94.3%）报告对治疗感到满意（n = 16）或非常满意（n = 17）。此外，根据普遍接受的失眠标准，65.7%的完成治疗者对治疗有反应。最后，34%的完成治疗者从CM转变为发作性偏头痛。
本研究为dCBT-I在有CM-I症状患者中的可行性和可接受性提供了证据。提示其对改善失眠和偏头痛有效果。这些结果表明需要进行一项随机对照试验来确定dCBT-I对CM患者的疗效。
