Kroon Van Diest AM, et al. - Treatment adherence was investigated in children and adolescents with chronic migraine who volunteered to be in a clinical trial using 3 measures: treatment session attendance, therapy homework completion, and preventive medication use by daily diary. The clinicians revealed that at attending therapy sessions, youth with chronic migraine who agreed to be a part of a clinical trial did quite well, and reported that they were adherent to completing home/practice between sessions and taking medication. These outcomes provided further support to consider cognitive-behavioral therapy plus amitriptyline (CBT+A) as a first-line treatment for youth with chronic migraine and proposed that measurement of adherence when this treatment was provided in practice would be important.

• Analyses were secondary from a trial of 135 youth (10 to 17 years) diagnosed with chronic migraine and with a Pediatric Migraine Disability Score over 20.
• The clinicians randomly assigned participants to cognitive-behavioral therapy plus amitriptyline (CBT+A, N=64) or headache education plus amitriptyline (HE+A, N=71).
• Therapists recorded session attendance.
• Completion of homework/practice between sessions was reported to therapists by patients.
• Using a daily headache diary, patients reported preventive medication adherence.

• For CBT+A, mean session attendance adherence out of 10 treatment sessions was 95% and 99% for HE+A.
• Between the 10 sessions, CBT+A participants reported completing a mean of 90% of the home practice of CBT skills.
• When missing diaries were excluded, participants reported taking amitriptyline daily at a mean level of 90% and 79% when missing diaries were considered as missed doses of medication.