Skip to main content
PMC home page
The Journal of Headache and Pain logoLink to The Journal of Headache and Pain
. 2010 Apr 8;11(3):215–225. doi: 10.1007/s10194-010-0192-5

MIPAS-Family—evaluation of a new multi-modal behavioral training program for pediatric headaches: clinical effects and the impact on quality of life

Wolf-Dieter Gerber 1,✉, Franz Petermann 2, Gabriele Gerber-von Müller 1, Maren Dollwet 3, Stephanie Darabaneanu 1, Uwe Niederberger 1, Ilva Elena Schulte 2, Ulrich Stephani 4, Frank Andrasik 3
PMCID: PMC3451914  PMID: 20376520

Abstract

Several meta-analyses have demonstrated that the combination of electrical muscle activity and Temperature Biofeedback could be regarded as gold standard in chronic pediatric headaches. However, these techniques seem to be uneconomical and furthermore they are not directed to improve the social competence as well as resolve possible impairments in daily activities of the child. Therefore, multi-modal behavioral techniques have been proposed, but no studies comparing these with the gold standard were conducted. The present study compared the impact of a new multi-modal behavioral education and training program—MIPAS-Family—with a combined Biofeedback treatment, evaluating clinical efficacy as well as the effect on the quality of life (QoL) of children with chronic headaches. Thirty-four children and adolescents with recurrent headache, ranging from 7 to 16 years, were randomly assigned to the MIPAS-Family (N = 19) or the Biofeedback (N = 15) condition. All patients were diagnosed by the criteria of the International Headache Society. The children and their parents completed headache diaries, diaries of daily living activities and a QoL questionnaire (KINDL®). Both groups showed significant improvements concerning the headache intensity and headache duration. We found no significant differences in the main headache parameters between both treatments. After the treatments, the children were less disturbed by their headaches in the domains school, homework, and leisure time. In conclusion, MIPAS-Family is as effective as Biofeedback but it is more cost-effective and addresses the whole family and the daily activities.

Keywords: Pediatric headaches, Biofeedback, MIPAS-Family Program, Education, Behavioral medicine

Full Text

The Full Text of this article is available as a PDF (220.7 KB).

Acknowledgments

Conflict of interest

None.

References

  • 1.Wang SJ. Epidemiology of migraine and other types of headache in Asia. Curr Neurol Neurosci Rep. 2003;3:104–108. doi: 10.1007/s11910-003-0060-7. [DOI] [PubMed] [Google Scholar]
  • 2.Fendrich K, Vennemann M, Pfaffenrath V, Evers S, May A, Berger K, Hoffmann W. Headache prevalence among adolescents—the German DMKG headache study. Cephalalgia. 2007;27:347–354. doi: 10.1111/j.1468-2982.2007.01289.x. [DOI] [PubMed] [Google Scholar]
  • 3.Unalp A, Dirik E, Kurul S. Prevalence and clinical findings of migraine and tension-type headache in adolescents. Pediatr Int. 2007;49(6):943–949. doi: 10.1111/j.1442-200X.2007.02484.x. [DOI] [PubMed] [Google Scholar]
  • 4.Winner P. Classification of pediatric headache. Curr Pain Headache Rep. 2008;12(5):357–360. doi: 10.1007/s11916-008-0060-z. [DOI] [PubMed] [Google Scholar]
  • 5.Oelkers-Ax R, Resch F. Kindliche Kopfschmerzen als Problem für die Kinder- und Jugendlichen Psychiatrie? Z Kinder Jugendpsychiatr Psychother. 2002;30(4):281–293. doi: 10.1024/1422-4917.30.4.281. [DOI] [PubMed] [Google Scholar]
  • 6.Hershey AD, Powers SW, Vockell AL, LeCates SL, Segers A, Kabbouche Development of a patient-based grading scale for PedMIDAS. Cephalalgia. 2004;24(10):844–849. doi: 10.1111/j.1468-2982.2004.00757.x. [DOI] [PubMed] [Google Scholar]
  • 7.Talarska D, Zgorzalewicz-Stachowiak M. The influence of selected factors on the quality of life of children with headaches. Adv Med Sci. 2007;2(52 Suppl 1):123–125. [PubMed] [Google Scholar]
  • 8.Bandell-Hoekstra I, Abu-Saad HH, Passchier J, Knipschild P. Recurrent headache, coping, and quality of life in children: a review. Headache. 2000;40(5):357–370. doi: 10.1046/j.1526-4610.2000.00054.x. [DOI] [PubMed] [Google Scholar]
  • 9.Bandell-Hoekstra IE, Abu-Saad HH, Passchier J, Frederiks CM, Feron FJ, Knipschild P. Coping and quality of life in relation to headache in Dutch schoolchildren. Eur J Pain. 2002;6(4):315–321. doi: 10.1053/eujp.2002.0343. [DOI] [PubMed] [Google Scholar]
  • 10.Frare M, Axia G, Battistella PA. Quality of life, coping strategies, and family routines in children with headache. Headache. 2002;42(10):953–962. doi: 10.1046/j.1526-4610.2002.02224.x. [DOI] [PubMed] [Google Scholar]
  • 11.Nodari E, Battistella PA, Naccarella C, Vidi M. Quality of life in young Italian patients with primary headache. Headache. 2002;42(4):268–274. doi: 10.1046/j.1526-4610.2002.02079.x. [DOI] [PubMed] [Google Scholar]
  • 12.Bussone G, Usai S, Grazzi L, Rigamonti A, Solari A, D’Amico D. Disability and quality of life in different primary headaches: results from Italian studies. Neurol Sci. 2004;25(Suppl 3):105–107. doi: 10.1007/s10072-004-0263-y. [DOI] [PubMed] [Google Scholar]
  • 13.Powers SW, Patton SR, Hommel KA, Hershey AD. Quality of life in paediatric migraine: characterization of age-related effects using PedsQL 4.0. Cephalalgia. 2004;24(2):120–127. doi: 10.1111/j.1468-2982.2004.00652.x. [DOI] [PubMed] [Google Scholar]
  • 14.Hershey AD. What is the impact, prevalence, disability, and quality of life of pediatric headache? Curr Pain Headache Rep. 2005;9(5):341–344. doi: 10.1007/s11916-005-0010-y. [DOI] [PubMed] [Google Scholar]
  • 15.Ferrari A, Pileri F, Spaccapelo L, Zappaterra M, Ruggerini C, Tacchi R, Bertolini A. How children and parents evaluate the headache centre’s intervention. Headache. 2009;49:194–201. doi: 10.1111/j.1526-4610.2008.01325.x. [DOI] [PubMed] [Google Scholar]
  • 16.Vannatta K, Getzoff EA, Powers SW, Noll RB, Gerhardt CA, Hershey AD. Multiple perspectives on the psychological functioning of children with and without migraine. Headache. 2008;48(7):994–1004. doi: 10.1111/j.1526-4610.2007.01051.x. [DOI] [PubMed] [Google Scholar]
  • 17.Andrasik F, Powers SF, McGrath PJ. Methodological considerations in research with special populations: children and adolescents. Headache. 2005;45:520–525. doi: 10.1111/j.1526-4610.2005.05104.x. [DOI] [PubMed] [Google Scholar]
  • 18.Holroyd KA, Drew JB. Behavioral approaches to the treatment of migraine. Semin Neurol. 2006;26(2):199–207. doi: 10.1055/s-2006-939920. [DOI] [PubMed] [Google Scholar]
  • 19.Trautmann E, Lackschewitz H, Kröner-Herwig B. Psychological treatment of recurrent headache in children and adolescents—a meta-analysis. Cephalalgia. 2006;26(12):1411–1426. doi: 10.1111/j.1468-2982.2006.01226.x. [DOI] [PubMed] [Google Scholar]
  • 20.Nestoriuc Y, Rief W, Martin A. Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators. J Consult Clin Psychol. 2008;76(3):379–396. doi: 10.1037/0022-006X.76.3.379. [DOI] [PubMed] [Google Scholar]
  • 21.Penzien DB, Rains JC, Andrasik F. Behavioral management of recurrent headache: three decades of experience and empiricism. Appl Psychophys Biofeedback. 2002;27(2):163–181. doi: 10.1023/A:1016247811416. [DOI] [PubMed] [Google Scholar]
  • 22.Hermann C, Blanchard EB. Biofeedback in the treatment of headache and other childhood pain. Appl Psychophys Biof. 2002;27(2):143–162. doi: 10.1023/A:1016295727345. [DOI] [PubMed] [Google Scholar]
  • 23.Hermann C, Kim M, Blanchard EB. Behavioral and prophylactic pharmacological intervention studies of pediatric migraine: an exploratory metaanalysis. Pain. 1995;60:239–256. doi: 10.1016/0304-3959(94)00210-6. [DOI] [PubMed] [Google Scholar]
  • 24.Larsson B, Carlsson J, Fichtel A, Melin L. Relaxation treatment of adolescent headache sufferers: results from a school-based replication series. Headache. 2005;45(6):692–704. doi: 10.1111/j.1526-4610.2005.05138.x. [DOI] [PubMed] [Google Scholar]
  • 25.Nestoriuc Y, Martin A. Efficacy of biofeedback for migraine: a meta-analysis. Pain. 2007;128(1–2):111–127. doi: 10.1016/j.pain.2006.09.007. [DOI] [PubMed] [Google Scholar]
  • 26.McGrath PJ, Cunningham SJ, Lascelles MA, Humphreys P. Help yourself. A treatment for migraine headaches. Ottawa: University of Ottawa Press; 1990. [Google Scholar]
  • 27.Dencke H, Kröner-Herwig B. Therapie des Kopfschmerzes im Kindesalter [Treatment of paediatric headaches] Med Rep. 1998;22:17. [Google Scholar]
  • 28.Kröner-Herwig B, Mohn U, Pothmann R. Comparison of biofeedback and relaxation in the treatment of pediatric headache and the influence of parent involvement of outcome. Appl Psychophys Biof. 1998;23:143–157. doi: 10.1023/A:1022267104369. [DOI] [PubMed] [Google Scholar]
  • 29.Kröner-Herwig B, Dencke H. Cognitive-behavioral therapy of pediatric headache: are there differences in efficacy between a therapist-administered group training and a self-help format? J Psychosom Res. 2002;53(6):1107–1114. doi: 10.1016/S0022-3999(02)00345-8. [DOI] [PubMed] [Google Scholar]
  • 30.Siniatchkin M, Darabaneanu S, Gerber-von Müller G, Niederberger U, Petermann F, Schulte IE, Gerber WD (2010) Kinder mit Migräne und Asthma: Zur Rolle der Eltern-kind Interaktion [Children with migraine and asthma: the role of the parent-child interaction]. Kindheit und Entwicklung 19:27–35
  • 31.Gerber WD, Stephani U, Kirsch E, Kropp P, Siniatchkin M. Slow cortical potentials in migraine families are associated with psychosocial factors. J Psychosom Res. 2002;5:215–222. doi: 10.1016/S0022-3999(02)00299-4. [DOI] [PubMed] [Google Scholar]
  • 32.Gerber WD, Petermann F, Gerber-von Müller G, Niederberger U, Rentmeister B, Siniatchkin M, Stephani U. MIPAS-Family—Entwicklung und Evaluation eines verhaltensmedizinisches Programms zur Behandlung kindlicher Kopfschmerzen [MIPAS—Development and evaluation of a behavioral program for paediatric headaches] Verhaltenstherapie. 2008;18:43–48. doi: 10.1159/000170912. [DOI] [Google Scholar]
  • 33.Gerber WD, Schoenen J. Biobehavioral correlates in migraine: the role of hypersensitivity and information-processing dysfunction. Cephalalgia. 1998;18(Suppl 21):5–11. doi: 10.1177/0333102498018s2103. [DOI] [PubMed] [Google Scholar]
  • 34.Gerber WD, Kropp R, Schoenen J, Siniatchkin M. „Born to be wild oder doch gelernt?” Neue verhaltensmedizinische Erkenntnisse zur Ätiopathogenese der Migräne [“Born to be wild or learned?” New behavioral medicine findings in the etiopathogenesis of migraine] Verhaltenstherapie. 1996;6:10–220. doi: 10.1159/000258991. [DOI] [Google Scholar]
  • 35.Arndorfer RE, Allen KD. Extending the efficacy of a thermal biofeedback treatment package to the management of tension-type headaches in children. Headache. 2001;41:183–192. doi: 10.1046/j.1526-4610.2001.111006183.x. [DOI] [PubMed] [Google Scholar]
  • 36.Andrasik F, Schwartz MS. Behavioral assessment and treatment of pediatric headache. Behav Modif. 2006;30(1):93–113. doi: 10.1177/0145445505282164. [DOI] [PubMed] [Google Scholar]
  • 37.Kerns RD, Rosenberg R. Pain-relevant responses from significant others: development of a significant-other version of the WHYMPI scales. Pain. 1995;61:245–249. doi: 10.1016/0304-3959(94)00173-C. [DOI] [PubMed] [Google Scholar]
  • 38.Bullinger M, Bruett AL, Erhart M, Ravens-Sieberer U, the BELLA Study Group Psychometric properties of the KINDL-R questionnaire: results of the BELLA study. Eur Child Adolesc Psychiatry. 2008;17:125–132. doi: 10.1007/s00787-008-1014-z. [DOI] [PubMed] [Google Scholar]
  • 39.Ravens-Sieberer U. The revised KINDL®: final results on reliability, validity and responsiveness of a modular HRQOL instrument for children and adolescents. Qual Life Res. 2001;10(3):199. [Google Scholar]
  • 40.Cohen J. A power primer. Psychol Bull. 1992;112:155–159. doi: 10.1037/0033-2909.112.1.155. [DOI] [PubMed] [Google Scholar]
  • 41.Rokicki LA, Holroyd KA, France CR, Lipchik GL, France JL, Kvaal SA. Change mechanisms associated with combined relaxation/EMG biofeedback training for chronic tension headache. Appl Psychophys Biof. 1997;22(1):21–41. doi: 10.1023/A:1026285608842. [DOI] [PubMed] [Google Scholar]
  • 42.Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral headache treatment: history, review of the empirical literature, and methodological critique. Headache. 2005;45(2):92–109. doi: 10.1111/j.1526-4610.2005.4502003.x. [DOI] [PubMed] [Google Scholar]
  • 43.Dencke H, Kröner-Herwig B (2000) Kopfschmerz-Therapie mit Kindern und Jugendlichen: ein Trainingsprogramm [Headache Therapy with children and adolescents: a training program]. Göttingen, Hogrefe
  • 44.Allen KD, Shriver MD. Role of parent mediated pain behavior management strategies in biofeedback treatment of childhood migraines. Behav Ther. 1998;29:477–490. doi: 10.1016/S0005-7894(98)80044-0. [DOI] [Google Scholar]
  • 45.McGrath PA. Commentary: psychological interventions for controlling children’s pain: challenges for evidence-based medicine. J Pediatr Psychol. 1990;2:172–174. doi: 10.1093/jpepsy/24.2.172. [DOI] [PubMed] [Google Scholar]
  • 46.Mérelle SY, Sorbi MJ, Doornen LJ, Passchier J. Lay trainers with migraine for a home-based behavioral training: a 6-month follow-up study. Headache. 2008;48(9):1311–1325. doi: 10.1111/j.1526-4610.2007.01043.x. [DOI] [PubMed] [Google Scholar]
  • 47.Gerber-von Müller G, Petermann U, Petermann F, Niederberger U, Stephani U, Siniatchkin M, Gerber Wd (2009) Das ADHS-Summercamp. Entwicklung und Evalution eines multimodalen Programms [The ADHD-Summercamp. Development and evalution of multimodal program]. Kindheit und Entwicklung 18:162–172

Articles from The Journal of Headache and Pain are provided here courtesy of BMC

RESOURCES