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Pediatric Chronic Headache Trial

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ClinicalTrials.gov Identifier: NCT00389038
Recruitment Status : Unknown
Verified April 2011 by Children's Hospital Medical Center, Cincinnati.
Recruitment status was:  Active, not recruiting
First Posted : October 17, 2006
Last Update Posted : April 25, 2011
Information provided by:

Study Description
Brief Summary:
The purpose of this trial is to evaluate the efficacy of combined behavioral and pharmacological treatment on chronic daily headache in children ages 10 to 17.

Condition or disease Intervention/treatment Phase
Headache Behavioral: Coping Skills Training Behavioral: Headache Education Drug: Amitriptyline Phase 3

Detailed Description:

Chronic daily headache (CDH)——defined as having headaches 15 or more days per month——is a frequent and debilitating condition in children that results in severe decreased quality of life and emotional stress. Very little is known about the most effective types of treatment for CDH in children and adolescents. Development of effective interventions for youth with CDH could potentially prevent the progression of a very painful and costly condition into adulthood. Treatments combining pharmacological (drug) interventions with behavior change have been found effective in treating adults with chronic pain, including headaches, but have been understudied in children.

The goal of this randomized, controlled clinical trial is to determine the efficacy of combined behavioral and drug treatment of CDH in youth ages 10 to 17. In the study, scientists will investigate if a combination of pain coping skills training (CST) and the drug amitriptyline (AMI)——CST-AMI——is effective in reducing headache frequency, functional disability, and symptoms of depression. More specifically, the researchers will evaluate if CST-AMI is superior to AMI combined with an attention control (ATT). The CST will mainly focus on learning skills for coping with pain, and the ATT will focus on understanding chronic headaches and lifestyle information.

Participants will be randomly assigned to one of the two treatment groups: CST-AMI or ATT-AMI. Those assigned to CST-AMI will complete 8 weekly sessions of coping training and 2 monthly maintenance-promoting sessions. Sessions will focus on teaching biofeedback, muscle relaxation techniques, imagery, distraction, activity pacing, problem solving, and calming techniques, using a treatment manual developed and tested in youth with CDH. Those assigned to ATT-AMI will receive the same amount of therapist support and attention but not the active behavioral training. All participants will receive the study medication, AMI.

Headache frequency, functional disability, pain and headache characteristics, quality of life, and symptoms of depression will be assessed before and after treatment, and reassessed at 3, 6, 9, and 12 months. For participants, duration of the study——which includes treatment and follow-up phases——lasts about 18 months. The treatment phase includes 12 study visits and the follow-up phase includes 4 study visits.

The long-term objective of this research is to establish effective treatments for CDH in youth that lead to significantly reduced headache frequency and functional disability.

Study Design

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 132 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Drug and Non-Drug Treatment of Pediatric Chronic Headache
Study Start Date : October 2006
Estimated Primary Completion Date : August 2012
Estimated Study Completion Date : September 2012

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Headache
U.S. FDA Resources

Arms and Interventions

Arm Intervention/treatment
Active Comparator: Coping Skills Training + Amitriptyline
Behavioral coping skills training--Behavioral Treatment session 1 and 2: Doses are one session a week for 8 weeks, followed by one session a month for 2 months, followed by 1 session every three months for 1 year.
Behavioral: Coping Skills Training
Behavioral Treatment 1 (coping skills training)--Behavioral Treatment session 1 and 2: Doses are one session a week for 8 weeks, followed by one session a month for 2 months, followed by 1 session every three months for 1 year.
Drug: Amitriptyline
Amitriptyline: up to 1 mg/kg capsule taken once daily at bedtime. Taken up to Week 20. After Week 20 medications and doses may change with standard care.
Active Comparator: Headache Education + Amitriptyline
Behavioral headache education
Behavioral: Headache Education
Behavioral Treatment 2 (headache education)
Drug: Amitriptyline
Amitriptyline: up to 1 mg/kg capsule taken once daily at bedtime. Taken up to Week 20. After Week 20 medications and doses may change with standard care.

Outcome Measures

Primary Outcome Measures :
  1. Headache diaries assess headache frequency. [ Time Frame: Completed one month prior to first visit, then weekly up to Week 20, then one month prior to Month 3, 6, 9, and 12 Follow-Up Visits. ]

Secondary Outcome Measures :
  1. The Child Depression Inventory. [ Time Frame: Completed at Baseline, Week 20, and Months 3, 6, 9, and 12. ]
  2. The PedsQL measures the impact of chronic illness and quality of life. [ Time Frame: Completed at Baseline, Week 20, and Months 3, 6, 9, and 12. ]
  3. Pediatric Migraine Disability Assessment (PedMIDAS) evaluates the impact of headaches on life activities. [ Time Frame: Completed at Baseline, Week 20, and Months 3, 6, 9, and 12. ]

Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   10 Years to 17 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • diagnosis of chronic daily headache based on definition of 15 or more headache days per month measured by a prospective daily headache diary
  • females or males between the ages of 10-17
  • PedMIDAS Disability Score > 20, indicating at least moderate disruption in daily activities

Exclusion Criteria:

  • medication overuse as defined in the ICHD-II criteria (NSAID or other simple analgesic on ≥ 15 days/ month for >3 months; triptan intake in any formulation ≥ 10 days/month on a regular basis of ≥ 3 months)
  • current treatment with amitriptyline
  • no other current prophylactic antimigraine medication within a period equivalent to < 5 half-lives of that medication before entering the screening phase
  • other chronic pain condition such as juvenile primary fibromyalgia syndrome, complex regional pain syndrome-II
  • abnormal findings on EKG
  • current or past history of severe orthostatic intolerance or severe levels of orthostatic dysregulation (orthostatic hypotension or postural orthostatic tachycardia syndrome)
  • significant documented developmental delay or impairments such as autism, cerebral palsy or mental retardation
  • present or lifetime psychiatric diagnosis that meets DSM-IV criteria for bipolar disorder, major depressive disorder or psychosis
  • PedMIDAS Disability Score of > 140, indicating need for multi-systemic therapies to address very significant level of disability
  • youth who are pregnant, or those females who are sexually active and not using a medically accepted form of contraception (barrier or hormonal methods) or do not agree to be abstinent during the study
  • disallowed medications/products: opioids, antipsychotics, antimanics, barbiturates, benzodiazepines, muscle relaxants, sedatives, tramadol
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00389038

United States, Ohio
Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Mail Location 3015
Cincinnati, Ohio, United States, 45229-3039
Sponsors and Collaborators
Children's Hospital Medical Center, Cincinnati
National Institute of Neurological Disorders and Stroke (NINDS)
Principal Investigator: Scott W. Powers, PhD, ABPP, FAHS Children's Hospital Medical Center, Cincinnati
More Information

Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Scott W. Powers, PhD ABPP FAHS, Professor, Co-Director of the Headache Center, Cincinnati Children's Hospital Medical Center
ClinicalTrials.gov Identifier: NCT00389038     History of Changes
Other Study ID Numbers: R01NS050536 ( U.S. NIH Grant/Contract )
1R01NS050536-01A1 ( U.S. NIH Grant/Contract )
First Posted: October 17, 2006    Key Record Dates
Last Update Posted: April 25, 2011
Last Verified: April 2011

Keywords provided by Children's Hospital Medical Center, Cincinnati:
coping skills training
attention control

Additional relevant MeSH terms:
Headache Disorders
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Brain Diseases
Central Nervous System Diseases
Amitriptyline, perphenazine drug combination
Antidepressive Agents, Tricyclic
Antidepressive Agents
Psychotropic Drugs
Analgesics, Non-Narcotic
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Adrenergic Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Adrenergic Agents
Neurotransmitter Agents
Antipsychotic Agents
Tranquilizing Agents
Central Nervous System Depressants