Medium-term effectiveness of online behavioral training in migraine self-management: A randomized trial controlled over 10 months

Aim This randomized, controlled trial examined the medium-term effectiveness of online behavioral training in migraine self-management (oBT; N=195) versus waitlist control (WLC; N=173) on attack frequency, indicators of self-management (primary outcomes), headache top intensity, use of rescue medications, quality of life and disability (secondary outcomes). Methods An online headache diary following the ICHD-II and questionnaires were completed at baseline (T0), post-training (T1) and six months later (T2). Missing data (T1: 24%; T2: 37%) were handled by multiple imputation. We established effect sizes (ES) and tested between-group differences over time with linear mixed modelling techniques based on the intention-to-treat principle. Results At T2, attack frequency had improved significantly in oBT (-23%, ES=0.66) but also in WLC (-19%; ES=0.52). Self-efficacy, internal and external control in migraine management - and triptan use - improved only in oBT, however. This indicates different processes in both groups and could signify (the start of) active self-management in oBT. Also, only oBT improved migraine-specific quality of life to a sizable extent. Conclusions oBT produced self-management gains but could not account for improved attack frequency, because WLC improved as well. The perspective that BT effects develop gradually, and that online delivery will boost BT outreach, justifies further research.