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Relaxation Treatment of Adolescent Headache Sufferers: Results From a School-Based Replication Series


  • Bo Larsson MD,

  • Jane Carlsson PhD, RPT,

  • Åsa Fichtel PhD,

  • Lennart Melin PhD

  • From the Department of Child and Adolescent Psychiatry, NTNU, Trondheim, Norway; At the time of the studies: Department of Child & Adolescent Psychiatry, Public Health and Caring Sciences, Uppsala University, S-751 83 Uppsala, Sweden (Larsson); Department of Public Health and Caring Sciences, Göteborg University, Göteborg, Sweden (Carlsson); Department of Public Health and Caring Sciences, Uppsala Science Park, Uppsala University, S-751 83 Uppsala, Sweden (Fichtel); and Department of Psychology, Uppsala University, Sweden (Melin).

Address all correspondence to Bo Larsson, Department of Child and Adolescent Psychiatry, NTNU, Klostergata 46/48, N-7489 Trondheim, Norway.


Background.—In recent reviews of psychological and drug treatment, relaxation training approaches have been found to be efficacious for children and adolescents suffering from recurrent tension-type headache (TTH), while biofeedback procedures provide effective help for migraine headache sufferers, primarily treated in tertiary clinics.

Objective.—In a school-based replication series, the effectiveness and efficiency of relaxation training provided within school settings were examined, in addition to the effects on various headache features and the maintenance of treatment gains at a 6 to 10-month follow-up.

Methods.—Over a 20-year period, 288 adolescents aged 10 to 18 years participated in seven randomized, controlled trials conducted within regular school health service settings. Subjects were included if they had suffered from frequent migraine or TTHs, or from both headache types for at least 1 year. Various formats of standardized relaxation training procedures were contrasted to different attention-control (ATCO) approaches or self-monitoring (SM) of headaches in prospective diary recordings.

Results.—The results showed that a therapist-administered relaxation approach was superior to self-help or school-nurse administered relaxation training approaches, ATCO conditions or SM of headaches. Students with TTHs responded positively to any form of relaxation training, whereas those with frequent migraine responded well only to therapist-administered relaxation. However, school-nurse administered procedures were found to be the most efficient form of relaxation treatment, in particular for adolescents suffering from TTHs. Total headache activity, the number of headache days and peak headache intensity were significantly reduced after relaxation treatment, in addition to medication usage. Treatment gains were well maintained at the 6 to 10-month follow-up.

Conclusion.—Therapist-assisted relaxation training is an effective treatment for adolescents suffering from frequent TTHs or migraine. However, such treatment administered by school-nurses administered within school health care settings is an efficient treatment approach for adolescents suffering from the most common form of primary headache, ie, TTHs.