This K23 Career Award application combines a training and research plan. Training Plan: The candidate's long-term career goal is to establish a programmatic line of research investigating ways to enhance the effectiveness of behavioral treatments for migraine. In order to accomplish this long-term goal, is it critical to obtain advanced training in: 1) designing, implementing, and evaluating clinical trials;2) effective behavioral and pharmacologic treatment for migraine;and 3) using tailored messaging approaches in behavioral treatments for health related disorders. Training will take place under the guidance of a mentorship team with expertise in these areas. Short-term goals will be met through a combination of formal coursework, directed readings, hands-on experiential training, professional seminars and workshops, and meetings with the primary and co-mentors. Research Plan: Nearly 20% of households in the United States have someone who suffers from migraine headache. Behavioral treatments are a first-line option for migraine prevention;however, <5% of migraine sufferers utilize behavioral treatments. Self-administered behavioral treatments have the promise of greater dissemination;however, they are typically mass-produced and cannot provide personalized feedback that is more likely to trigger change. Tailored messaging can make self-administered behavioral treatment for migraine prevention personally relevant and, thus, in theory, be more efficacious than generic self administered, behavioral treatment. Preliminary findings from a pilot study conducted by the PI indicate that a Tailored Behavioral Strategies for Preventing Migraine (TABS-PM) treatment may be an efficacious self administered behavioral treatment for migraine prevention. The research portion of this K Award seeks to extend this line of research by conducting a randomized controlled trial (RCT) evaluating the efficacy of TABS-PM + usual care relative to generic behavioral strategies for preventing migraine (GBS-PM) + usual care or to usual care alone. The RCT will recruit 84 primary episodic migraine sufferers from a large primary headache center. The primary outcome will be change in the number of headache days per month from baseline to post-treatment (assessed daily using the Experience Sampling Program software installed on Palm handheld devices for a 4-week baseline and 4-week post-treatment period). Secondary outcomes include change in day with elevated headache triggers and headache-related disability. If TABS-PM were found to have superior efficacy to usual care, this would indicate that TABS-PM is an efficacious behavioral intervention for reducing episodes of migraine. If TABS-PM were found to have superior efficacy to generic self-administered behavioral treatment, this would indicate that tailoring messages is an important part of maximizing the efficacy of self-administered behavioral treatments for migraine prevention.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
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Study Section
NST-2 Subcommittee (NST)
Program Officer
Porter, Linda L
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Saint Louis University
Public Health & Prev Medicine
Schools of Medicine
Saint Louis
United States
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Lipton, Richard B; Serrano, Daniel; Nicholson, Robert A et al. (2013) Impact of NSAID and Triptan use on developing chronic migraine: results from the American Migraine Prevalence and Prevention (AMPP) study. Headache 53:1548-63
Smith, Timothy R; Nicholson, Robert A; Banks, James W (2010) Migraine education improves quality of life in a primary care setting. Headache 50:600-12
Nicholson, Robert A (2010) Chronic headache: the role of the psychologist. Curr Pain Headache Rep 14:47-54
Nicholson, Robert A; Kreuter, Matthew W; Lapka, Christina et al. (2008) Unintended effects of emphasizing disparities in cancer communication to African-Americans. Cancer Epidemiol Biomarkers Prev 17:2946-53
Nicholson, Robert; Bigal, Marcelo (2008) Screening and behavioral management: obesity and weight management. Headache 48:51-7
Smith, Timothy; Nicholson, Robert A (2007) Review of duloxetine in the management of diabetic peripheral neuropathic pain. Vasc Health Risk Manag 3:833-44
Nicholson, Robert A; Houle, Timothy T; Rhudy, Jamie L et al. (2007) Psychological risk factors in headache. Headache 47:413-26
Smitherman, Todd A; Nicholson, Robert A; Penzien, Donald B (2007) Osteopathic treatment versus ""relaxation"" for tension-type headache. Headache 47:450-1;author reply 451-2
Nicholson, Robert A; Rooney, Megan; Vo, Kelly et al. (2006) Migraine care among different ethnicities: do disparities exist? Headache 46:754-65
Nicholson, Robert A; Smitherman, Todd A (2006) Noise as a trigger for headaches? A comment. Headache 46:1592-4; author reply 1594-6