CHRONIC HEADACHE EDUCATION AND SELF-MANAGEMENT STUDY (CHESS) – A FEASIBILITY STUDY

Problem

Chronic headaches i.e. headaches on more than 15 days per month for more than three months effect around 2-4% or the population. CHESS is a five year programme of work leading to a multi-centre, randomised controlled trial (RCT) evaluating an education and self-management support programme for people with chronic headaches. Incorporated into the programme was a 12 month feasibility study, the main aims of which were: to test strategies for recruiting people with chronic headache from primacy care, develop and evaluate a telephone headache classification interview for chronic headaches that can be used by a non-headache expert, select the most appropriate patient reported outcomes and develop and test our study intervention prior to the RCT.

Approach

We recruited general practices in the West Midlands and developed a search strategy to identify patients aged >18 years who had consulted with migraine, tension type and medication overuse headache or prescribed migraine specific medication in the preceding 12 months. We held a consensus conference to reach consensus on the key content of a logic model to underpin the telephone classification interview. We measured level of agreement between interviews conducted by a nurse trained to use the classification interview and a doctor specialised in headache. We reviewed evidence and conducted cognitive interviews to identify and explore the acceptability and relevance of headache specific measures and generic quality of life measures. Participants were asked to complete postal questionnaires and test a smartphone app collecting headache frequency, severity and duration. Informed by evidence and using the MRC framework for complex interventions we developed and piloted a group based education and self-management intervention for people with chronic headache.

Findings

14 practices took part in the study with a combined practice population of 128,634 Searches identified 1827 potential participants (14.2/1,000) and a 36% invited were interested in the study, about half were eligible and the final recruitment rate around 1.0/1,000. 107 paired headache classification interviews were completed and level of agreement was very good. We received 131 baseline questionnaires and 115 (88%) two week and 103 (81%) 12 week follow up questionnaires. A small sample of participants tested the smartphone app and did not report any difficulties downloading or using the app.We developed a two day group intervention delivered by a nurse and allied health profession, followed by a one-to-one consultation with a nurse and up to eight weeks telephone support. We piloted the CHESS intervention in four groups and feedback from participants was positive.

Consequences

This study has allowed us to test our research processes and develop and test our study intervention and successfully demonstrated the feasibility of the main CHESS trial which started recruitment in June 2017.