A pilot randomized controlled trial to assess the impact of motivational interviewing on initiating behavioral therapy for migraine

Objective: Relaxation, biofeedback, and cognitive behavioral therapy are considered grade‐A, evidence‐based behavioral therapies (BT) for migraine. Despite the efficacy of these BTs, only ∼50% of patients initiate BT recommended by their headache specialists. Motivational interviewing (MI) is a BT to help patients explore and overcome ambivalence to enact positive change in their lives. We tested whether telephone‐based MI improves initiation, scheduling, and attending BT for migraine prevention. Methods: Participants, consecutively recruited during their appointments with headache specialists, participated in a single blind randomized controlled trial comparing telephone‐based MI to treatment as usual (TAU). Inclusion criteria: age 16‐80, ICHD criteria migraine diagnosis, and referral for BT for migraine prevention during the same appointment. Exclusion criteria: participation in BT for migraine in the past year. Non‐clinicians trained in MI conducted MI calls. MI group participants received max 5 MI calls. Both groups were called ∼3 months to collect data. Statistical analyses: descriptive statistics, t‐tests and logistic regression. Results: 76 patients were enrolled and randomized (n=36 MI, n=40 TAU), mean age: 39±12, 95% female, all had health insurance. Mean number of headache days/ month: 12.0±9.0. 70.9% were moderately‐severely disabled(via migraine disability assessment scale (MIDAS)). The mean number of MI calls/participant: 2.69±1.56 [0‐ 5], mean call time:12.10±5.13 [4‐28] mins. MI group participants were more likely to initiate making an appointment (65.6% vs. 40.7%, P=0.03), no difference in scheduling (34.4% vs. 22.2%, P=0.30) or attending (21.9% vs. 22.2%, P=0.97). Conclusion: Telephone‐based MI improved initiation rates for BT, but not rates of attendance or scheduling appointments. Many barriers identified in prior studies seem to lessen the effect of telephone‐based MI on scheduling and attending BT appointments. Future studies might be conducted to combine MI and problem‐solving approaches targeting other patient barriers to following BT recommendations. (Figure Presented) .