Cognitive behaviour therapy tailored to migraine in multiple sclerosis: A pilot randomized controlled trial

Approximately 50% of people with relapsing-remitting multiple sclerosis (RRMS) have comorbid migraine. This pilot randomized controlled trial examined the feasibility and preliminary efficacy of a five-week cognitive behaviour therapy targeted to treating migraine in RRMS (CBT-MMS). Participants with RRMS and ≥3 migraine days per month (MMD) received CBT-MMS or a nine-week waitlist. Feasibility was assessed by rates of retention, follow-up and outcome responses. Candidate primary outcomes were MMD, migraine duration, and pain intensity at baseline, post-treatment, and one-month follow-up. Secondary outcomes included mood, fatigue, self-efficacy, pain catastrophizing, disability and quality of life. Data were analyzed through multilevel modelling. Participants were 31 adults aged 22-59 with 8.32 ± 6.12 MMD at baseline. The retention rate was 96.77%. From baseline, the CBT-MMS group (<i>n=</i>21) had significantly fewer MMD and shorter migraine duration (in hours) at post-treatment (<i>EMM=</i>3.05 days, 95%CI [-5.32, -2.13]; <i>EMM</i>=6.34 h, 95%CI [-10.62, -5.15], respectively) and follow-up (<i>EMM</i>=2.82 days, 95%CI [-5.58, -2.33]; <i>EMM</i>=7.20 h, 95%CI [-9.64, -4.39], respectively). The waitlist group (<i>n=</i>10) had no such within-group changes. Treatment gains were found for anxiety, self-efficacy, and migraine-related disability, and no effects were found on remaining outcomes. These findings provide preliminary support for the feasibility and efficacy potential of CBT-MMS, warranting a larger-scale trial.