Date Presented 04/8/21
Pediatric chronic headache and its associated hypersensitivities to light and sound significantly disrupt participation in daily occupations. This study examined the effectiveness of auditory and visual desensitization through an exposure approach. Promising results indicate significant reduction in symptoms and significant improvement in functioning. OTs should strongly consider using desensitization to treat and manage pediatric headache–related hypersensitivities.
Primary Author and Speaker: Megan Silvia
Additional Authors and Speakers: Erin Foster
Contributing Authors: Beau M. Ances
PURPOSE: Pediatric headache disorders are a significant global health concern. Up to 60% of youth experience this persistent pain for at least three months (Abu-Arafeh et al., 2010). Such pain results in decreased quality of life and considerable impact upon roles, routines, and participation in daily occupations (Langdon & DiSabella, 2017). Hypersensitivities to light and sound are common symptoms of pediatric headache. For decades, standard medical advice for headache management has been to identify and avoid lights and sounds that may precipitate or exacerbate headaches. Thus, many youth with headache disorders avoid environments or activities where they may encounter such stimuli. Recent adult research, however, indicates that confronting headache triggers through desensitization results in reduced functional disability (Martin et al., 2014). Still, there are no known studies examining desensitization in youth with headache. This study examined the effectiveness of auditory and visual desensitization in reducing sensory sensitivities and related functional impairment in youth with headaches.
DESIGN: This longitudinal case-series study examined 130 youths, aged 9-22 (M age = 14.9 years, SD = 2.1), with a chronic headache disorder diagnosis (e.g., new daily persistent, migraine, post-concussive). Participants were enrolled in a day-hospital pediatric pain rehabilitation program (M tx-length = 4.7 weeks). During individualized occupational therapy (∼60 min./session, 5 sessions/week), participants were gradually introduced to light and sound stimuli in a controlled environment. Desensitization was graded, such that participants began with short, low-intensity exposure to stimuli and progressed to longer exposure, and novel, more intense stimuli.
METHOD: Participants completed questionnaires assessing headache-related functional disability (Headache Impact Test), performance and satisfaction on self-selected occupations (Canadian Occupational Performance Measure), and impact of their headache-related light and sound sensitivities (Headache-Related Sensitivity Questionnaires). All outcome variables were assessed at three timepoints: initial evaluation (pre-treatment), discharge evaluation (post-treatment), and two months post-discharge (follow-up). Repeated-measures ANOVAs with post-hoc analyses were used to measure significant change across timepoints.
RESULTS: Repeated-measures ANOVAs for all outcomes demonstrated statistically significant change over time in the hypothesized directions (all p < .001). Post-hoc analyses revealed significant decreases from pre-treatment to post-treatment in light sensitivity (p < .001), sound sensitivity (p < .001), and headache-related disability (p < .001). Significant increases in functional performance and satisfaction (p < .001) were also noted at these timepoints. Functional gains assessed at post-treatment were maintained or further improved at follow-up.
CONCLUSION: These results suggest that auditory and visual desensitization is a promising intervention for youth with chronic headaches. This study has shown that using desensitization in this population is associated with significant reductions in light and sound sensitivity and related avoidance behaviors, as well as reductions in the overall impact of headaches on functioning. Desensitization is also associated with significant improvements in occupational performance in and satisfaction with daily activities.
IMPACT STATEMENT: OTs treating youth with chronic headaches should strongly consider adding auditory and visual desensitization to their repertoire. Gradually exposing their patient to feared or avoided headache triggers facilitates significant improvement to the patient's health, well-being, and participation in everyday occupations.
References
Abu-Arafeh, I., Razak, S., Sivaraman, B., & Graham, C. (2010). Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol, 52(12), 1088-1097. https://doi.org/10.1111/j.1469-8749.2010.03793.x
Langdon, R., & DiSabella, M. T. (2017). Pediatric Headache: An Overview. Curr Probl Pediatr Adolesc Health Care, 47(3), 44-65. https://doi.org/10.1016/j.cppeds.2017.01.002
Martin, P. R., Reece, J., Callan, M., MacLeod, C., Kaur, A., Gregg, K., & Goadsby, P. J. (2014). Behavioral management of the triggers of recurrent headache: a randomized controlled trial. Behav Res Ther, 61, 1-11. https://doi.org/10.1016/j.brat.2014.07.002
