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A One-day Treatment Workshop for Comorbid Migraine and Depression

In Session With Lilian Dindo, PhD:

A One-day Treatment Workshop for Comorbid Migraine and Depression


September 3, 2012

Lilian Dindo, PhD


Assistant Professor, Departments of Psychiatry and Psychology, University of Iowa College of Medicine, Iowa City, IA


First published in Psychiatry Weekly, Volume 7, Issue 17, on September 3, 2012


Q: What led your team to devise a 1-day behavioral treatment for people with concurring migraine and depression?

A: Migraine is very common, affecting around 35 million people in the US. Studies have shown that as many as 40% of migraineurs suffer from comorbid depression. According to prospective studies, the relationship between migraine and depression is bidirectional—those with migraine are at greater risk for developing depression, and those with depression are at greater risk for migraine.

My colleagues, James Marchman, PhD, and Ana Recober, MD, and I developed a 1-day workshop of “Acceptance and Commitment Training plus Migraine Education” (ACT-ED) for patients with comorbid migraine and depression. We chose a 1-day workshop because we wanted to ensure the transportability of the treatment into clinical settings, and we were aware of research showing that treatment adherence and completion is one of the greatest obstacles to the effective delivery of mental health services. For example, in practical settings, most patients do not attend the 12–15 sessions used in many gold-standard psychotherapy trials. Secondly, research has shown that most improvements in psychotherapy occur during the first 4–5 sessions. We concluded that a 1-day workshop could address these issues and would ensure that patients receive the entire intervention.

Q: How does ACT-ED work, and how can it benefit patients?

A: The ACT component incorporates acceptance and mindfulness strategies with behavioral change strategies, with the goal of enhancing psychological flexibility. Patients are taught new ways of managing troubling thoughts, feelings, and physical sensations, and how to notice, and willingly face, experiences that cannot be changed. Patients are also encouraged to think about what is important and meaningful to them and what they want out of life; to recognize ineffective patterns of behavior and then how to engage in effective and committed actions that move them toward the life they want. The migraine education component involves educating participants about migraine itself, such as its natural course, triggers for symptom worsening, etc.

Our study included 31 participants in the ACT-ED workshop and 14 participants continued with their treatment-as-usual (TAU). We found that, at 3-month follow-up, the ACT-ED group exhibited significantly greater improvements in Hamilton Rating Scale for Depression scores than TAU, and a significantly larger proportion of ACT-ED participants no longer met criteria for depression compared to TAU. The ACT-ED group also exhibited greater improvements in functioning and headache-related disability at follow-up.

We are currently working on a separate manuscript showing that the ACT-ED participants also exhibited greater improvements in migraine pain and frequency compared to TAU. So although the primary goal of ACT is not symptom reduction, we observed significant symptom reduction—a frequent finding in ACT treatment trials. It is possible that helping people reengage in what matters in their lives, while learning ways to reduce struggles with pain, helps improve depressive symptoms in migraine sufferers.


Disclosure: Dr. Dindo reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest.


Dindo L, Recober A, Marchman JN, Turvey C, O’Hara MW. One-day behavioral treatment for patients with comorbid depression and migraine: A pilot study. Behav Res Ther. 2012;50:537-543.