Cognitive-Behavioral Therapy in Children with Chronic Migraines

A Study That Suggests CBT is an Effective Migraine Therapy with Medication

How Can You Treat Your Child's Migraines?. Blend Images-JGI/JamieGrill/Getty Images

Nearly 2 percent of the pediatric population suffer from chronic migraine. Yet, the Food and Drug Administration (FDA) has not approved a therapy for treatment of chronic migraine in children or adolescents. So, how does your child's neurologist or headache specialist treat your precious one's head pain?

One study in JAMA compares two regimens for treating children and adolescents with chronic migraines:

  • Cognitive-Behavioral Therapy (CBT) + amitriptyline
  • Health education + amitriptyline

What is Amitriptyline?

Amitriptyline (Elavil)  is an tricyclic antidepressant that works by blocking the reuptake of two neurotransmitters in the brain, serotonin and norepinephrine.  It's a sedating medication and typically taken at bedtime. It's FDA approved as a migraine preventive medication for adults.

What is Cognitive-Behavioral Therapy?

Cognitive-behavioral therapy, or CBT, entails learning how to identify headache triggers and cope with them in a more adaptive, less stressful manner.

How was the Study Organized?

In the study, 135 children and adolescents, between the ages of 10 and 17, who suffered from chronic migraine, were randomly assigned to either the CBT + amitriptyline group or the health education + amitriptyline group. Each participant underwent 8 weekly therapy sessions that were one-hour in duration.

The participants and their parents were blinded as to whether they were receiving CBT versus health education during these sessions.

All of the participants were given a dose of amitriptyline of 1mg/kg/day at dinner time. The children and adolescents were allowed to take medication for acute migraine abortion, like NSAIDs and triptans, but were not allowed to use them for more than 3 times per week.

Also, the participants maintained a headache diary to record various headache measures such as headache occurrence, duration, and associated symptoms.

What Did the Study Find?

By 20 weeks, 66 percent of participants in the CBT + amitriptyline group achieved a 50 percent or more reduction in days with headache compared to 36 percent of the participants in the health education + amitriptyline group.

At the one-year followup mark, 86 percent in the CBT + amitriptyline group had  a  50 percent or more reduction in headache frequency versus 69 percent in the health education + amitriptyline group.

In terms of migraine disability (meaning how a child's migraines affects his or her everyday functioning), those who received CBT with amitriptyline had a greater improvement in their migraine disabiity score when compared to those who received health education with amitriptyline. 

Bottom Line

The use of cognitive-behavioral therapy with amitriptyline in children and adolescents with chronic migraine reduced the number of migraines and their migraine-related disability when compared to health education with amitriptyline.

This suggests that CBT is a reasonable and effective treatment for chronic migraine in the pediatric population.

If your child suffers from chronic migraine, discuss the use of a behavioral intervention, like CBT, with his or her healthcare provider. Remain an informed and proactive parent in your child's health.


Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

Lipton, R.B., et al. (2011). Prevalence and burden of chronic migraine in adolescents. Headache, 51(5):693-706.

Power, S.W., et al. (2013). Cognitive Behavioral Therapy Plus Amitriptyline for Chronic Migraine in Children and Adolescents: A Randomized Clinical Trial. JAMA, ;310(24):2622-2630.

Verhagen, A.P., Damen, L,, Berger, M.Y., Passchier, J,, & Koes BW. (2009). Behavioral treatments of chronic tension-type headache in adults: are they beneficial? CNS Neuroscience and Therapeutics, Summer;15(2):183-205.

DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.

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