The benefits of 2 self-help training programs (multimodal cognitive-behavioral training [CBT] and applied relaxation [AR]) presented via the Internet were compared by researchers from the University of Göttingen, in Germany.

First, the details.

  • 65 children and adolescents (average age: 13 years) with recurrent headache (at least 2 per month) were assigned to a treatment group.
    • CBT presented via the Internet
    • AR presented via the Internet
    • Educational intervention not involving the Internet
  • Changes in headache frequency, intensity, duration and frequency were recorded.
  • Pain catastrophizing and general well-being (depression, psychopathological symptoms, and health-related quality of life) were also reported.

And, the results.

  • All groups had a significant reduction in headache frequency, duration, and pain catastrophizing.
  • There were no differences in headache intensity, depression, psychopathological symptoms, or health-related quality of life.
  • Rates of response by the end of treatment were 63% for CBT, 32% with AR, and 19% for educational intervention.
  • Statistical analysis of the results show that it requires 2 people to be treated with CBT for 1 person to benefit, vs 5 for AR and educational intervention.
  • At follow-up, no significant differences were found (CBT: 63%, AR: 56%, educational intervention: 55%).

The bottom line?

The abstract is short on details. For example it fails to tell us the duration of treatment and the timing of follow-up.

That said, in this study, children and adolescents treated with CBT showed improvement in headache frequency, duration, and pain catastrophizing.

And these results are supported by other studies of Internet-based treatment. Researchers from the Netherlands and Sweden recently conducted a review of 12 studies and concluded, “Internet interventions targeting pain were comparable to the effects found for face-to-face treatments, and the same was true for interventions aimed at headache.”

Offering CBT  through the Internet potentially saves therapist time, reduces waiting-lists, eliminates travel time, and provides an opportunity to reach patients who can’t easily access more traditional forms of treatments. What’s needed is a study to confirm these benefits in order to make the Internet more available as a reimbursed healthcare service.

4/24/10 17:13 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.