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Nearly 2% of children and adolescents experience chronic migraine (≥15 headache days/month), but no FDA-approved interventions exist for this condition in youth. Both cognitive behavioral therapy (CBT) and amitriptyline have been shown to be effective as single agents for management of chronic pain and headache. In a randomized trial, researchers examined whether the combination of amitriptyline plus CBT is superior to amitriptyline plus headache education in 135 patients (mean age, 14 years; 79% female) seeking care at an academic medical center headache clinic. Patients had a mean of 21 headache days/month and severe disability on a pediatric migraine disability assessment (mean, 68 on a 0–240 point scale).
All patients received amitriptyl…