Digital cognitive behavioural therapy for insomnia in women with chronic migraines

Crawford, Megan R. and Luik, Annemarie I. and Espie, Colin A. and Taylor, Hannah L. and Burgess, Helen J. and Jones, Alex L. and Ong, Jason C. (2020) Digital cognitive behavioural therapy for insomnia in women with chronic migraines. Headache. ISSN 1526-4610

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    Objective/Background: Insomnia commonly co-occurs with chronic migraines (CM). Non-pharmacological treatments for insomnia in CM patients remain understudied. This is a proof-of-concept study, which aims to evaluate the feasibility, acceptability and preliminary efficacy of a digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) for individuals with CM and insomnia (CM-I) in the US. Methods: We recruited 42 females with CM and insomnia symptoms from a US based observational cohort and from the general population via adverstisements. Within a multiple baseline design, participants were randomized to receive dCBT-I after two, four or six weeks of completing baseline sleep diaries. DCBT-I was scrutinised against benchmarks for completion rates (≥ 90% to complete dCBT-I), acceptability (≥ 80% to find dCBT-I acceptable), and post-treatment changes in insomnia symptoms (≥ 50% indicating a clinically relevant improvement in their insomnia symptoms). As a secondary measure, we also reported percentage of individuals reverting to episodic migraines. Results: Out of 42 randomized, 35 (83.3%) completed dCBT-I within the 12 weeks provided. Of these completers, 33 (94.3%) reported being satisfied (n=16) or very satisfied (n=17) with treatment. Additionally, 65.7% of completers responded to treatment as per universally accepted criteria for insomnia. Lastly, 34% of completers reverted from CM to episodic migraine. Conclusion: This study provides evidence for the feasibility and acceptability of dCBT-I in patients with CM and insomnia complaints. Effects of improving insomnia and migraines were suggested. These results indicate that a randomized controlled trial is needed to determine the efficacy of dCBT-I in CM patients.