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Dynamics of Changes in Self-Efficacy and Locus of Control Expectancies in the Behavioral and Drug Treatment of Severe Migraine

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Modification of expectancies (headache self-efficacy and headache locus of control) is thought to be central to the success of psychological treatments for migraine.

Purpose

The purpose of this study is to examine expectancy changes with various combinations of Behavioral Migraine Management and migraine drug therapies.

Methods

Frequent migraine sufferers who failed to respond to 5 weeks of optimized acute migraine drug therapy were randomized to a 2 (Behavioral Migraine Management+, Behavioral Migraine Management−) × 2 (β-blocker, placebo) treatment design.

Results

Mixed models for repeated measures analyses (N = 176) revealed large increases in headache self-efficacy and internal headache locus of control and large decreases in chance headache locus of control with Behavioral Migraine Management+ that were maintained over a 12-month evaluation period. Chance headache locus of control and socioeconomic status moderated changes in headache self-efficacy with Behavioral Migraine Management+.

Conclusions

The “deficiency” hypothesis best explained how patient characteristics influenced changes in of headache self-efficacy with Behavioral Migraine Management.

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Notes

  1. Studies that experimentally manipulate “perceived success” and/or other treatment elements (physiological learning) may provide information about change mechanisms, but have experimentally altered clinical treatment, and thus fail to provide information about changes in expectancies that occur when treatment is administered in the clinical setting [56–58].

  2. All variables examined in the moderator analyses, other than ethnicity, are continuous variables. However, the terms “high” and “low” are used for readability.

  3. The most recent clinical trials of preventative migraine medication tend to report dropout rates of 50% at 6 months. In contrast, the Treatment of Severe Migraine trial has a dropout rate of 35% at 10 months. Thus, crudely averaged over months, the dropout rate for the Treatment of Severe Migraine trial (≈3.5% per month) was less than half of the comparative dropout rate for other recent preventative medication trials (≈8% per month). Another way to compare dropouts across trials is to note that the dropout rate for the Treatment of Severe Migraine trial at 16 months is similar to the dropout rate for other recent trials at 6 months.

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Acknowledgments

We would like to thank the following people for their assistance in carrying out the TSM trial: Constance Cottrell, Francis O’Donnell, Gary Cordingley, Carol Nogrady, Kimberly Hill, Victor Heh, Suzanne Smith, Bernadette Devantes Heckman, Brenda Pinkerman, Gregg Tkachuk, Sharon Waller, Donna Shiels, Kathleen Darchuk, Yi Chen, Timur Skeini, Manish Singla, Swati Dalmai, Lori Arnott, and Lina Himawan. Support for this trial was provided by grant NS-32374 (awarded to Dr. Holroyd) from the National Institutes of Health. Merck Pharmaceuticals, Inc and GlaxoSmithKline Pharmaceuticals donated triptans (5-HT1B/D-agonists) for acute migraine therapy, which was their only involvement.

Conflict of Interest Statement

Ms. Seng reports no conflicts of interest. Dr. Holroyd has received support from the National Institutes of Health (NINDS; NS32375), has consulted for ENDO Pharmaceuticals and Takeda Pharmaceuticals North America, and received an investigator initiated grant from ENDO Pharmaceuticals.

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Authors and Affiliations

  1. Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH, 45701-2979, USA

    Elizabeth K. Seng M.S. & Kenneth A. Holroyd Ph.D.

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  1. Elizabeth K. Seng M.S.
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  2. Kenneth A. Holroyd Ph.D.
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Correspondence to Elizabeth K. Seng M.S..

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Dr. Holroyd has full control of all primary data from the TSM trial. All analyses were conducted by Ms Seng.

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Seng, E.K., Holroyd, K.A. Dynamics of Changes in Self-Efficacy and Locus of Control Expectancies in the Behavioral and Drug Treatment of Severe Migraine. ann. behav. med. 40, 235–247 (2010). https://doi.org/10.1007/s12160-010-9223-3

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