Relaxation training was compared to two control placebo psychological methods of treatment in 99 children and adolescents with frequent migraine at the Children's Hospital of Eastern Ontario, University of Ottawa, Canada. Relaxation methods consisted of 6, one-hour, weekly sessions in which children were taught sequential tensing and relaxation of large muscle groups and the use of deep breathing. Placebo treatment consisted of therapy sessions to teach recognition of emotions, relating them to life situations, and to urge discussion of feelings daily with a friend or parent. A second control method labelled “own best efforts” consisted of a single session to discuss the use of the headache diary to determine triggering factors. The value of the treatments were determined by questionnaires concerning headache frequency and severity and confidence in the method and therapist. Patients in all three treatment groups showed a significant reduction in headaches following treatment for 4 weeks and at 3 and 12 month follow-up. Relaxation training was no more effective than brief reassurance and self-control suggestion techniques in treating pediatric migraine. [1]

COMMENT. The incidence of migraine in children and adolescents has been estimated at 5 - 7%. Pharmacological intervention has been the usual approach to treatment but self-regulation methods may be helpful and may reduce reliance on drugs of doubtful efficacy. In one well-controlled trial, propranolol was ineffective when compared to placebo [2]. The average duration of headache was greater during the propranolol period (40 mg two or three times daily) and the frequency was not reduced. Food allergy has been emphasized as a causative factor, and dietary therapy eliminating such foods as cow's milk, egg, chocolate, orange, and wheat, or other allergenic items has been proposed as an alternative to drugs in childhood migraine [3] and [4]: see p. 91 of this issue of Ped Neur Briefs).