Testing myWHI: Online Self-help Programs for Headaches

Study Overview
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Brief Summary
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This randomized controlled trial will compare the effectiveness of two online self-guided programs for youth and young adults with migraine against usual care.

Official Title
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Comparative Effectiveness of Two Self-guided Web-based Interventions for Youth and Young Adults With Migraine

Conditions
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Migraine Disorders

Intervention / Treatment
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* Behavioral: SPHERE
* Behavioral: PRISM


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: aged 14-40 years fluent in the English language (i.e., speaking, reading and writing); for 14-17 year olds: suffer from headaches for a minimum of three months for 18-40 year olds: suffer from headaches for a minimum of one year suffer from migraine headaches as indicated with a score of 2 and above on the ID Migraine have a Smartphone as PRISM has been designed to be accessed from a Smartphone and SPHERE encompasses the myWHI diary which has also been designed to be used from a Smartphone use the Smartphone for activities other than texting and calling (e.g., email, Facebook) as the programs are designed for migraineurs who are familiar with using Smartphones and use them in their daily life have daily Internet access from their Smartphone, because running the programs require an Internet connection minimum of four headache days during 4 weeks that they are asked to use an electronic headache diary Exclusion criteria: health care professional has not ruled out any underlying medical condition related to their headaches (e.g., head trauma, meningitis) are pregnant, planning to get pregnant (in the next 4 to 6 months), or breastfeeding, as hormonal changes are known to exert potent influences on migraine headaches have an impairment which compromises their ability to give informed consent having been diagnosed with psychosis and/or schizophrenia, because a past or current diagnosis may likely interfere with the participants ability to fully participate in the study have participated in our recent three-armed pilot RCT (i.e., any participant who consented and was randomized) they complete less than 50% of daily entries (i.e., less than 14 daily entries) in an electronic headache dairy when they asked to use it for 4 weeks More than 15 headache days during the 4 weeks that they are asked to use an electronic headache diary

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: SPHERE<br>It is an online self-guided comprehensive cognitive-behavioural therapy program that offers a headache diary, learning modules that teach a variety of cognitive and behavioural skills to cope better with their headaches, and a discussion forum where users may interact. | Behavioral: SPHERE<br>* Comprehensive Internet-based CBT program with no human support<br>|
| Experimental: PRISM<br>It is an online self-guided brief cognitive-behavioural therapy program that offers a headache diary and helps users discover their headache triggers and non-triggers. Then the program provides the users with a few personalized recommendations to help them to cope with their triggers. | Behavioral: PRISM<br>* Brief Internet-based CBT program with no human support<br>|
| No Intervention: Usual care<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinically significant improvement (50% reduction or greater) in number of headache days in a 4-week period from baseline to 4-months post-randomization | An electronic headache diary will be asked to be used for 4 weeks. Each day participants will be asked to record whether or not they have experienced a headache. | At baseline and at 4-months post-randomization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Statistically significant improvement in peak headache severity in a 4-week period from baseline to 4-months post-randomization | An electronic headache diary will be asked to be used for 4 weeks. On days that participants report a headache(s) in the diary, they will be asked to rate highest headache intensity for the day using the 11-point Numerical Rating Scale (NRS-11). The peak headache severity will be calculated in two different ways: (1) the average of the highest headache intensity per week over the 4-week period, and (2) the number of days that participants have reported a headache episode with a NRS-11 of 8 or higher over the 4-week period. | At baseline and at 4-months post-randomization | 
| Statistically significant improvement in headache-related functional impairment from baseline to 4-months post-randomization | We will measure impairment with either the Migraine Disability Assessment Scale -Pediatric version (PedMIDAS) for ages 14-18 years or the Migraine Disability Assessment Scale (MIDAS) for ages 19-40 years. MIDAS and PedMIDAS measure headache-related functional impairment. We will use the total score, which is the sum of answers across the 6 items for PedMIDAS and the sum of answers across the 5 items for MIDAS. A higher score indicating greater impairment. | At baseline and at 4-months post-randomization | 
| Statistically significant improvement in depressive symptomatology from baseline to 4-months post-randomization. | The Centre for Epidemiological Studies - Depression Scale (CES-D) will be used to measure depressive symptomatology. Responses will be summed to provide a total score that can range from 0 to 60; with higher scores indicating the presence of more symptoms and higher frequency. | At baseline and at 4-months post-randomization | 
| Level of acceptability to the treatments (i.e., PRISM and SPHERE) | The 8-item Client Satisfaction Questionnaire (CSQ-8) will be used to measure level of acceptability to the treatments. The total score will be used. The total score is the sum of item responses and ranges from 8 to 32, with higher scores indicating higher levels of satisfaction. | At 4-months post-randomization | 
| Level of acceptability to the treatments (i.e., PRISM and SPHERE) | The single-item Patients' Global Impression of Change (PGIC) Scale will be used to measure level of acceptability to the treatments. The PGIC is 7-point categorical scale (very much improved to very much worse) to report the perceived improvement with an intervention. | At 4-months post-randomization |