Die “Freiburger Migränestudie”

Zusammenfassung

In der “Freiburger Migränestudie” wurde die Wirksamkeit verschiedener Intervalltherapieformen bei der Migräne, so von Metoprolol, psychologischen Methoden sowie einer Kombinationstherapie langfristig miteinander verglichen. 63 Patienten mit Migräne ohne Aura bzw. mit kurzer Aura wurden randomisiert den Therapiegruppen zugewiesen. An eine Baseline-Phase von 8 Wochen schloß sich eine Intensivtherapiephase von 3 Monaten an. Die erste Katamnese wurde unmitelbar im Anschluß an diese Intensivtherapiephase 2 Monate lang erhoben. Eine zweite Katamnese von wiederum 8 Wochen Dauer folgte ein halbes Jahr nach Therapieende. Erfolgsparameter waren: Attackenhäufigkeit, mittlere Kopfschmerzintensität, Kopfschmerzdauer, Migränedauer, Analgetikaverbrauch, Konsum analgetischer Mischpräparate, Stimmung. Das psychologische Behandlungsprogramm unfaßte 12 zweistündige Sitzungen in kleinen Gruppen mit der in der Studie tätigen Psychologin und enthielt folgende inhaltliche Schwerpunkte: Progressives Muskelrelaxationstraining nach Jacobson, Techniken zur Schmerzbewältigung und Strategien zur Streßbewältigung. Wird eine Variable berücksichtigt, finden sich 62,5% Responder in der ersten Katamnese, bei zwei Variablen sind die Resultate deutlich schlechter. Über die Erhebungsphasen hinweg besteht ein Aufwärtstrend. Responder-Prozent-Werte im Rahmen der zeitreihenanalytischen Auswertung zeigten für die einzelnen Erfolgsparameter Werte bis 31%. Die Wirkung des psychologischen Programms ist eher langfristig anzusetzen. Subjektiv schätzten die Patienten ihren Therapieerfolg weitaus besser ein als die statistischen Resultate dies widerspiegeln.

Abstract

This study was designed to evaluate the efficacy of different strategies for migraine prophylaxis over a fairly long period. Metoprolol alone was compared with psychotherapy alone and with a combination of metoprolol and psychotherapy. The psychological programme was planned for future use in preventive treatment. In this paper only the results of the psychological therapy are described.

Patients and methods

Criteria for inclusion of patients were: migraine without aura or with short aura for at least 2 years, and 2–10 attacks per month. In all, 63 patients (11 men and 52 women) were each randomized for participation one of the three kinds of treatment. All patients declared their willingness to participate in all three different therapies. After neurological and psychological diagnosis the baseline phase of 2 months was started, followed by the intensive therapy phase lasting 3 months. The end of the intensive therapy is followed by a first 2-month follow-up period. A second follow-up of 2 months was started 6 months after the end of intensive therapy. Psychological diagnosis involved the following elements: a migraine questionnaire, a list of patient’s complaints, a depression scale and a psychological exploration. All patients kept a diary during all phases of the study with daily descriptions of their headaches, the therapy and their mood. The psychological programme lasted for 12 sessions of 2 hours each. A psychologist worked with small groups of up to 5 patients This programme was composed of progressive relaxation techniques (Jacobson) and techniques aimed at overcoming pain and stress.

The data on diagnosis, the baseline phase, the intensive therapy phase and the two follow-up phases were analysed by conventional statistics (comparison of mean values,t-test, variance analysis, non-parametric tests) and by time series analysis. The parameters analysed were: frequency of attacks, mean headache intensity, duration of headache and migraine, consumption of analgesic drugs and mood. Analysis of the questionnaires and the different diagnostic data revealed no significant differences between the three different groups of therapy.

Results

A significant improvement in one or at least two measured parameters is shown in Table 1. The results, with 62.5% responders for one parameter in the first follow-up phase are rather positive. If two variables are required to improve significantly the results become worse. Over the different phases the results improve slightly, probably due to the effect of training. In the time series analysis the percentage of responders was calculated to show the number of responders for a particular variable (Table 3). For the different parameters the percentage of responders varied between 0 and 31.3%.

Conclusions

According to the results, the efficacy of the psychological treatment increases only gradually, as it has also been demonstrated for biofeedback and relaxation training [9]. Subjectively, patients rate the results of psychotherapy higher than those demonstrated by statistics. This may depend on the selection of patients, but also on the fact that subjective criteria of improvement are not contained in statistical evaluation. Responders and non-responders had initial differences regarding vegetative, hormonal and psychological factors. Responders had a more stable circulatory status, suffered more rarely from menstrual migraine and normally took significantly fewer analgesic drugs. On the whole, this psychological programme has proved quite effective.