A clinical trial of a self-care approach to the management of chronic headache in general practice

This paper reports a trial which assessed the clinical effectiveness of adding a behavioural self-management programme to the existing management of chronic headache by general practitioners (GPs). Eighty-seven chronic headache sufferers, referred to the study by 35 GPs, were randomly allocated to either a self-care group or a GP-control group. Headaches, drug usage, visits to health-care providers and time off work were self-monitored daily by all subjects for 4 weeks prior to intervention, for 4 weeks during intervention, and for 4 weeks immediately after intervention. Additionally, self-monitoring was carried out for two further 4-week periods, one at 6 months and one at 12 months post intervention. Headache records showed that the self-care program significantly enhanced GP management. This effect was well maintained. However, drug usage, visits to health-care providers and time off work did not differ significantly between the treatment and control groups. 'No-show' rates, defined as those referred by a GP but who did not attend, were high--largely due to time requirements of the self-care program. However, drop-out rates, defined as those who left the self-care groups were low. It was concluded that this behavioural self-management program was a clinically effective adjunct to general practice management of headache but its use is likely to be limited due to problems of patient enrollment.