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Relaxation Treatment Administered by School Nurses
to Adolescents with Recurrent Headaches
Asa Fichtel, PhD, MSc; Bo Larsson, MD
Posted: September 2004  
Headache 2004; 44:545-554

Objective:  To study the outcome of two different forms of relaxation training administered by school nurses to adolescents suffering from recurrent headaches in an effectiveness study.

Methods:  A total of 11 school nurses were randomized to administer one of the two treatments to 63 adolescents. A post hoc group with 42 untreated subjects, matched for headache diagnosis, sex, and age were included as a control group.

Results:  The results showed no pre-post differences in headache reduction between the treatment groups, however, subjects treated with either of the two relaxation approaches were significantly more improved than those in the post hoc group on total headache activity and headache-free days. Clinical improvement (at least 50% improvement) was attained among 19% of the treated subjects as compared to 7% for those in the post hoc group, a nonsignificant difference. Higher functional disability predicted a worse outcome, and positive self-statements predicted better outcome. Altogether, these variables accounted for 29% of the outcome variance in the total headache activity.

Conclusions:  In the present study, outcomes of relaxation training as administered by school nurses were not found to be as powerful as similar treatments provided for adolescents with migraine or tension-type headache in the previous controlled studies of clinic as well as school samples. If it is likely that the school nurses need to be more thoroughly trained and informed to achieve cost-effective improvement. Presently, it is suggested that the relaxation training should not be used as a part of regular treatment in the school health care for adolescents with recurrent headaches until further evidence is provided.