MigraineManager: A Self-Management Health Care Resource for Pediatric Migraine

Cincinnati Childrens Hosp Med Ctr, Cincinnati OH

Investigators

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Abstract

Project Summary/Abstract Poor disease self-management is a significant issue in pediatric migraine as comprehensive treatment for migraine includes behavioral pain management, medication therapy, cognitive-behavioral therapy, and lifestyle modification. With the annual cost of nonadherence in US health care exceeding $100-300 billion, self- management of chronic conditions is critical to reducing morbidity and health care expenses. We have identified numerous factors that interfere with adolescents' ability to effectively self-manage including treatment burden, forgetting, catastrophizing, negative beliefs about treatment efficacy, and lack of parental support/monitoring. Although these barriers are amenable to behavioral intervention/CBT, many adolescents lack the self-management skills to overcome them on their own, and clinic-based self-management efforts have proven inadequate. Through our intervention research, we have demonstrated the efficacy of multicomponent self-management intervention and CBT for migraine treatment. However, the proportion of the migraine population that could receive this type of treatment is restricted due to limited access (e.g., lack of available trained clinicians, distance between patient homes and treatment facility). The overall goal of this project is to design, prototype, and evaluate the preliminary efficacy of a self-management internet resource, MigraineManager, that can be used by pediatric patients with migraine, their parents, and the clinicians who treat them, with the aim of improving patient care and self-management and, consequently, health outcomes. This will provide easy access to an evidence-based self-management resource for patients and families and improve self-management support efforts and data for clinicians who treat patients with migraine. We will develop MigraineManager via an iterative process with engagement and repeated input from all key stakeholders in self-management (i.e., patients, parents, and clinicians). We will integrate evidence based assessment and intervention approaches including behavioral self-management techniques, CBT, and lifestyle modification, and target key outcomes of self-management (i.e., medication adherence and headache frequency). Our team is diverse and represents significant breadth and depth of expertise in headache medicine, self-management, behavioral science, cognitive-behavioral treatment, biostatistics, web-based intervention and programming, and patient engagement. MigraineManager will impact public health by providing an evidence-based resource to a large proportion of patients who otherwise would not receive treatment, thereby reducing health care disparities for families that have limited access to services. Given the health and economic impact of poor self-management, this study is timely and important, as it has the potential to positively impact migraine health outcomes, and serve as a model for self-management intervention in other pediatric populations.