Development of an educational and self-management intervention for chronic headache - CHRONIC HEADACHE EDUCATION AND SELF-MANAGEMENT STUDY (CHESS).
Chronic headache is defined as headaches on 15 or more days per month over a 3 month period. They effect 2-4% of the population with the main impact being on young adults many of whom have both work and family commitments. Self-management programmes have been used in a range of chronic diseases however there was limited evidence for use in the treatment of chronic headaches when NICE produced recommendations in 2012. Our aim is to develop and evaluate an education and self-management support intervention for chronic headache, specifically, migraine, tension type and medication overuse headaches.
The development of the intervention has been informed by several components including three systematic reviews; 1) on educational and/or self-management interventions for chronic headache; 2) predictors of poor outcomes from headache disorders and; 3) the lived experiences of chronic headache. We have also collected qualitative interview material on the lived experiences of chronic headache and drawn on our knowledge from an existing intervention package for people living with chronic musculoskeletal pain. These data were bought together at an intervention development meeting comprising of the academic team, clinical team and lay people living with chronic headaches.
The CHESS intervention comprises of self-management and education topics including acceptance, mood and headache, recognising unhelpful thought patterns and behaviours, stress management, sleep management, medication management, communication and mindfulness. This is a two day group intervention delivered by a nurse and allied health professional. The focus of the first day is on living, understanding and dealing with chronic headaches whereas the second day focuses on managing life with chronic headaches. Each participant subsequently receives a one to one consultation with the nurse to diagnose their headache type and discuss medication, lifestyle factors and goal setting. Ongoing telephone or email support is also provided for a period of up to eight weeks.
The intervention has been piloted in four groups, totalling 20 participants within the West Midlands. As part of this pilot our process evaluation team have interviewed the intervention facilitators and participants to identify what worked well and what requires change before formal testing. The overall feedback has been very promising.
We have developed a complex intervention package after drawing on the evidence base and learning from the pilot phase. We have adapted the intervention based on feedback from participants and facilitators ready for a multicentre randomised controlled trial to begin in 2017.