Trans-diagnostic Cognitive-behavioral Therapy for Treatment of Migraine
Trans-diagnostic Cognitive-behavioral Therapy for Treatment of Migraine
Migraine headache is one of the disabling conditions that may be associated with decreased
 quality of life, anxiety and depression. Currently, therapeutic approach to migraine is
 mostly based on prophylactic and acute phase medication therapy. Some investigators consider
 migraine a biopsychosocial condition which means that psychological therapies, such as
 cognitive-behavioral therapy and relaxation, may be efficient in controlling the disease.
 According to previous studies, cognitive therapies, including cognitive-behavioral therapy,
 have been efficient in decreasing frequency and severity of migraine, however, there are some
 challenges in applying these kind of interventions: the expenses; presence of multiple
 commodities that may lead to confusion and bewilderment for both therapist and patient; small
 number of trained psychologists for this intervention.

 The trans-diagnostic approach, however, can facilitate some challenges with the previous
 method. Since it is not focused on a single condition, trained psychologists with this
 approach can apply it for a wide range of conditions, including migraine. Also, the
 trans-diagnostic approach leads to lower chances of confusion and bewilderment for therapist
 and patients. The trans-diagnostic approach focuses on therapeutic modules instead of
 constant similar therapeutic models. The five cores of trans-diagnostic approach are
 emotional awareness, cognitive flexibility, recognizing and preventing emotion avoidance and
 maladaptive emotion driven behaviors, awareness and tolerance of emotion-related physical
 conditions, and introceptive and situation-based emotion-focused exposure. This method was
 first designed to replace cognitive-behavioral therapy for emotional disorders, due to its
 feasibility and applicability.

 The trans-diagnostic approach has been investigated by several researchers so far, however,
 most of those researches evaluate the efficacy of the technique on psychiatric disorders. It
 has also been investigated for treatment of headaches in adolescents. But no other study on
 other clinical problems or migraine has been conducted. Considering the high rates of
 comorbid anxiety and depressive symptoms in migrainous patients and the feasibility and
 efficacy of trans-diagnostic cognitive-behavioral therapy in other conditions, we aimed to
 evaluate its efficacy on controlling headache and related symptoms among migrainous patients.
Migraine headache is one of the disabling conditions that occurs more in young women. It is
 usually associated with decreased quality of life, as well as anxiety and depressed in the
 affected individuals. Currently, therapeutic approach to migraine is mostly based on
 medication therapy in two phases of prophylaxis and acute attacks. However, some
 investigators consider it not only as a biologic disease, but also a multidimensional
 condition that may be accompanied by anxiety and depressive symptoms. Considering migraine as
 a biopsychosocial condition means that psychological therapies, such as cognitive-behavioral
 therapy and relaxation, may be efficient in controlling the disease. According to previous
 studies, cognitive therapies, including cognitive-behavioral therapy, have been efficient in
 decreasing frequency and severity of migraine, however, there are some challenges in applying
 these kind of interventions for patients: the costs of such treatments are usually not
 covered by insurance companies; presence of multiple commodities may lead to confusion and
 bewilderment for both therapist and patient while applying the technique; training
 psychologists for this intervention is costly and not enough psychologists know how to handle
 the condition.

 The trans-diagnostic approach, however, can facilitate some challenges with the previous
 method. Since it is not focused on a single condition, trained psychologists with this
 approach can apply it for a wide range of conditions, including migraine. Also, the
 trans-diagnostic approach leads to lower chances of confusion and bewilderment for therapist
 and patients.

 The trans-diagnostic approach is somehow similar to the classic cognitive-behavioral therapy.
 however, it focuses on therapeutic modules instead of constant similar therapeutic models.
 The five cores of trans-diagnostic approach are emotional awareness, cognitive flexibility,
 recognizing and preventing emotion avoidance and maladaptive emotion driven behaviors,
 awareness and tolerance of emotion-related physical conditions, and introceptive and
 situation-based emotion-focused exposure. This method was first designed to replace
 cognitive-behavioral therapy for emotional disorders, due to its feasibility and
 applicability.

 The trans-diagnostic approach has been investigated by several researchers so far, however,
 most of those researches evaluate the efficacy of the technique on psychiatric disorders. It
 has also been investigated for treatment of headaches in adolescents. But no other study on
 other clinical problems or migraine has been conducted. Considering the high rates of
 comorbid anxiety and depressive symptoms in migrainous patients and the feasibility and
 efficacy of trans-diagnostic cognitive-behavioral therapy in other conditions, we aimed to
 evaluate its efficacy on controlling headache and related symptoms among migrainous patients.
Inclusion Criteria:

 -  Diagnosis of migraine headache by primary neurologist based on the criteria defined by
 International Classification of Headache Disorders III Beta (ICHD-III Beta).

 -  Diagnosed with migraine at least 6 months prior to enrollment

 -  High school graduate or higher level of education

 Exclusion Criteria:

 -  Medication overuse based on the criteria defined by ICHD-III Beta (taking
 non-steroidal anti-inflammatory drugs or other pain relievers at least 15 days in each
 month; taking triptans or similar drugs at least 10 days each month for 3 months or
 more)

 -  Addition of no new prophylactic migraine medication during the study

 -  suffering from other types of headache disorders

 -  Being treated with other psychological therapies (psychotherapy, ...) during the
 study.

 -  Not being able to fill our self-administered questionnaires (illiteracy, cognitive
 problems)

 -  Altered cognitive or mental status, like dementia