Chronic headache represent one of the most common and disabling medical conditions affecting adolescents, with a sizeable proportion of those affected continuing to have significant impairment into their adult years. Many of these children must exclusively rely on suboptimal medical treatments that in some cases can worsen headache conditions due to limited access to other forms of effective treatment. Cognitive-behavioral treatment for headache has demonstrated efficacy yet is available to only a small fraction of those adolescents who may most benefit. The goal of the proposed research program is to develop, test, and ultimately disseminate an internet-based cognitive-behavioral headache management product capable of becoming part of the standard of care for effectively treating primary headache disorders in adolescent patients. Research during the initial phase will determine the likely commercial viability of the proposed product through evaluating the scientific validity of the product content, the likelihood of physicians to recommend the product to patients and colleagues, the receptiveness of intended product users to the product content and design, and the technical feasibility of using an internet-based format for treating adolescents with chronic headaches. Core program content and design features will be iteratively refined during this initial research based on survey and focus group feedback from headache specialists and from the intended users of the program (children aged 13-18 with a primary headache disorder and their parents/caregivers). Approximately 100 healthcare providers specializing in headache management will receive descriptions of the program content and design and complete surveys inquiring about clinical relevance, scientific validity, utility in clinical practice, and likelihood of recommending this type of product to patients and colleagues. Following modifications to the program based on provider feedback, child and parent/caregiver focus groups comprising 16 participants in total (8 children with primary headache disorders and 8 parent/caregivers) will be recruited from neurology clinics at a large freestanding pediatric hospital. Focus group participants will be shown descriptions and sample images of the proposed program and asked to comment in detail through verbal discussion and structured surveys on the appropriateness, attractiveness, appeal, and perceived utility of the content and design. Subsequently, two child and two caregiver sample lessons will be developed by computer programmers taking into account the focus group and healthcare provider feedback. Sample lessons will be programmed using Macromedia Flash software and will contain audio, video, animation, and interactivity tailored to the given user based on an integrated on-line daily headache tracking system. Focus group participants will be re-contacted to complete the sample lessons on home computers and will be asked to provide additional feedback on appeal and technical feasibility through structured on-line surveys. Resulting data will be summarized with descriptive statistics and analyzed to determine whether proceeding forward with further research and development efforts in this area appears justified.
Chronic headache disorders affect a substantial and rising number of teenagers and represent a significant public health concern given the level of disability and impairment they often cause throughout adolescence and into adult life. The proposed research and development efforts have the capacity to effectively address this significant public health concern through using an easily accessible format (the internet) to equip the millions of adolescents who have disabling chronic headaches with scientifically sound and clinically effective headache self-management strategies.
