Chronic Headache Education and Self-management Study (CHESS)

Background Headache disorders are a major cause of pain and disability. Chronic headache, defined as at least 15 headache days per month for at least three months, is the major cause of this. The commonest chronic headache disorders are tension type (TTH), migraine, and medication overuse headaches (MOH). TTH and migraine headaches are primary headaches. MOH is a secondary headache that can develop in people taking headache remedies on more than 10-15 days per month. Self-management support programmes have an established place in the management of a range of chronic diseases.[1-3] NICE, when developing headache guidelines, did not find any useable evidence on the use of education and self-management programmes for the treatment of chronic headaches and recommended further research. We will need to develop a structured diagnostic interview that will allow non-expert clinicians to distinguish and diagnose the three main, sometimes coexisting, common chronic headache types. Work is needed to select the most appropriate patient reported outcomes for our trial. Work is needed to develop a combined intervention for chronic headaches. This will need to include a tailored educational component, focussed on the use of medication, alongside a self-management support element based on cognitive behavioural principles which, amongst other things, will address illness beliefs. Aim To develop and test a support programme consisting of tailored education and generic components for people living with chronic headache. Objectives To develop and test strategies for recruiting people living with chronic headache from primary care To develop and evaluate a brief diagnostic interview to support diagnosis for people living with chronic headaches, focussing on the diagnosis of the three common chronic headache disorders; migraine, TTH and MOH, To develop and pilot an education a new self-management support intervention for the management of common chronic headache disorders (migraine, TTH, MOH) that is both theoretically informed and based on best available empirical evidence. To select most appropriate patient reported outcome measures for CHESS. To run a pragmatic randomised controlled trial, including an economic evaluation, of the CHESS intervention. To run formative and summative process evaluations of both the trial and the intervention Proposed research We propose six workstreams, each of which will address one of our objectives. We will develop and test strategies to identify people living with chronic headache from general practice consultation records. We will recruit around 170 participants from six – eight practices as a sampling frame for our exploratory studies (workstreams 2-4). To improve diagnosis of headache type we will develop a structured diagnostic interview for use by non-specialist clinicians. We will review existing literature on diagnostic tools, seek expert opinion, and confer with patient partners to develop a prototype diagnostic interview. In our feasibility population we will test the validity of the diagnostic interview by using expert clinicians diagnoses based on transcripts of the interviews. Informed by multiple new systematic reviews, and current best practice, we will develop a new intervention. We anticipate this will consist of a diagnostic interview that will inform personalised advice on headache management, including use of medication, plus a generic headache group self-management support programme. This self-management support programme will draw on theories of behaviour change. To pilot, and evaluate, the programme we will run it with around 50 people with chronic headaches. We will do a systematic review, and an interview study to inform a consensus meeting to select patient reported outcomes. We will evaluate the performance of candidate measures in our feasibility sample. To measure short term outcomes we will use a smart phone based data collection system. We will run a