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Table 2 Summary of results from reviews and influences on intervention design

From: Development of an education and self-management intervention for chronic headache – CHESS trial (Chronic Headache Education and Self-management Study)

Key findings Influences on intervention design
Style and content review [22]
To review the effectiveness of self-management interventions for headaches and highlight the differential components included and delivery methods used
Inclusion of CBT The overall intervention is informed by the core principles of cognitive behavioural therapy (CBT). The focus being on unhelpful thinking patterns and the need to recognise such thought processes and look for alternatives that are more helpful. Participants have the opportunity to explore the different types of unhelpful thought patterns and subsequently reflect on the challenges these create and ways to make them more helpful/manageable.
Inclusion of education The programme is an educational and self-management intervention and therefore includes topics that carry a large educational component. This includes topics such as ‘headache information and mechanisms’ and ‘medication management.’
Inclusion of mindfulness As part of a taster session, mindfulness is included. Participants are provided with a mindfulness CD for home practice.
Inclusion of relaxation Relaxation is included as a taster session and participants are provided with a copy of the relaxation CD for home practice.
Group interventions more effective The intervention is group based, aiming to get between 8 and 10 participants per group.
Face to face and remote delivery did not make much of a difference As this is a complex intervention with several components, we felt a face-to-face, group intervention with a built in one to one consultation would be the best option based on previous experience from the team in delivering complex interventions.
Homework - no difference in studies offering this and not We included homework as part of our intervention to enable bedding in of information and discussions from day one and to allow any uncertainties to be clarified on day 2. Participants are encouraged to make use of the relaxation CD and to watch the headache DVD.
Email/telephone support – no difference in studies offering this and not Telephone follow-up is provided as a means of supporting those who are implementing changes and in particular those who might be withdrawing from medication. The frequency of these calls are individually negotiated between the nurse and the participant.
No indication that delivery by a Psychologist or Psychotherapist was any more or less effective than a nurse or Allied Health Professional (AHP) The collaborative team carefully considered who should facilitate the delivery of the intervention. Due to the medical aspects of headaches around mechanisms, medication and headache classification a nurse was deemed most appropriate.
Lived experiences review [35]
To synthesis the qualitative literature on the lived experience of people with chronic headache disorder
Headaches act as a driver to increase medication We have specifically included a session on medication to allow exploration of acute and preventative medication. Focus is also given to the concept of medication overuse headaches and subsequently the opportunity to discuss this during a one to one consultation.
Headaches lead to avoidance in planning The intervention includes the headache pain cycle and the need to break the cycle. We explore the skills associated with identifying barriers to change and using problem solving and goal setting as a means to engaging in meaningful activity. Participants are encouraged to complete their own goal-setting plan and to bring that to the one to one appointment for discussion.
Headaches encouraged changes in sleep patterns Sleep management is included as a session to enable participants to understand the link between sleep and thoughts and subsequently look at what is, and is not, recommended for good sleep management.
Headaches a driver to stopping doing things The headache pain cycle is used to discuss a feeling of being trapped and therefore withdrawing. This is further explored to identify strategies to help break this cycle.
A sense of loss of control The whole intervention is designed to educate and encourage those with chronic headaches to explore strategies to help them better manage their headaches and improve their quality of life. As part of this journey we explore the concept of control and the implication this can have on headaches.
Prognostic review [36]
To identify predictors of prognosis in studies of those with chronic headache
Depression and anxiety The intervention includes topics around the link between mood and headaches and the impact this can have. We provide participants with a handout outlining the possible symptoms of depression and advise to seek support from their GP if they are struggling with these. Mindfulness and relaxation are built in as strategies to help manage mood and anxiety.
Medication overuse This is covered as a topic in the facilitated group sessions and then further discussed during the one to one consultation, if relevant.
Poor sleep The concept of a balanced and healthy lifestyle is facilitated as a topic during the group sessions. As part of this, sleep and effective sleep management strategies are discussed.
High stress Sessions on managing stress and anxiety are included. Participants are encouraged to explore the impact of stress and anxiety and subsequently look at strategies for management. Relaxation and mindfulness are introduced as strategies to manage stress and participants are encouraged to practice these at home.
Headache management self-efficacy The course is designed in inform, empower and build confidence in those with headache to take control and use self-management strategies to help them manage their headaches better.