Effectiveness of Internet Cognitive Behavioral Therapy and Psychoeducation for Workers with Chronic Tension Headaches: A randomized controlled trial (Japanese)

Background: Tension-type headaches are associated with significant socioeconomic costs through reduction of employee productivity and quality of life. The purpose of this study was to determine whether internet-computerized cognitive behavioral therapy (iCBT) was superior to psychoeducation (PE) in improving headache. Methods: After approval by the Institute Review Board, workers who gave their informed consent, who were aged 20 to 50 years with chronic tension-type headaches, were included in the study. A randomized controlled trial to compare iCBT with PE was conducted for 6 weeks. The primary outcome was the Brief Pain Inventory (BPI). The secondary outcomes were headache intensity (Headache Impact Test: HIT-6), catastrophic thinking, anxiety, depression and so on. Results: 514 participants were randomly assigned to the two groups. 399 participants (iCBT: n=141, PE: n=258) who performed at least once for 6 weeks were analyzed. There was no significant difference of BPI as the primary outcome between the two groups. As the secondary outcomes, PHQ-15 at 6 weeks and HIT-6 at 12 weeks were significantly reduced in iCBT, compared with that in PE. No significant differences of the other secondary outcomes between the two groups were found. Comparing within-group, the mean changes of BPI were significantly reduced in iCBT (-0.48) and in PE (-0.50) at 6 weeks from baseline. HIT-6 and PCS were also significantly reduced at 6 weeks from baseline in both groups. Conclusions: No significant differences were found in the primary outcome between the two intervention groups for tension-type headaches. Although the results must be interpreted with caution because of a lack of comparison with a waitlist control group or pharmacotherapy, this study suggested simple Internet-based self-help psychological interventions including iCBT and PE could act as alternatives to using drugs to improve tension-type headaches.