Efficacy of a multidisciplinary 5-day headache day-clinic program: A prospective quasi-experimental pre-post study in primary headache disorders

Headache. 2026 May 12. doi: 10.1111/head.70133. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effects of a short, structured multimodal day-clinic program on health-related quality of life and disability in patients with primary headache disorders.

BACKGROUND: Although monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway have substantially advanced migraine prophylaxis, a large proportion of patients remain insufficiently controlled. Residual disability, comorbidities, and contraindications highlight the need for complementary nonpharmacological approaches. Multimodal programs combining medical, psychological, and behavioral strategies have proven effective in chronic pain but remain insufficiently studied in primary headache populations, particularly in the context of modern pharmacological options.

METHODS: In this quasi-experimental pre-post study at the neurological day clinic of University of Greifswald, we investigated a 5-day multimodal treatment program delivered by an interdisciplinary team. Patients were recruited between January and July 2021. The intervention comprised medical consultations, psychological therapy, physiotherapy, occupational therapy, structured education, and relaxation training. Patient-reported outcomes were assessed with the Veterans RAND 12-Item Health Survey (VR-12; primary end points: mental component summary [MCS] and physical component summary [PCS]), the Depression Anxiety Stress Scales (DASS-21), the Headache Impact Test (HIT-6), and headache diaries. Assessments were performed during the pre-admission waiting period (V0), at admission (V1), and at 3, 6, and 9 months after treatment (V2-V4). Primary analyses focused on changes from baseline to 3 months, with exploratory analyses for extended follow-up.

RESULTS: A total of 92 patients were included, most with migraine (83%). The VR-12 MCS improved significantly over time (F[2,162] = 3.23, p = 0.042; nominal), increasing from an estimated marginal mean of 36.9 (95% CI, 33.35-40.45) at baseline (V0) to 38.3 (95% CI, 35.54-41.06) at V1, and 41.5 (95% CI, 37.55-45.45) at 3 months (V2). Focusing on the pre-specified baseline-to-3-month contrast, MCS improved from V0 to V2 (mean difference, 4.63; 95% CI, 1.02-8.24; p = 0.012; Holm-Bonferroni p_adj = 0.024). PCS showed no significant changes (F[2,162] = 0.95, p = 0.387), with estimated marginal means of 38.3 (95% CI, 36.13-40.47) at V0, 37.7 (95% CI, 35.73-39.67) at V1, and 39.0 (95% CI, 36.24-41.76) at V2. Headache frequency did not change significantly across V0-V2 (F[2,148] = 0.49, p = 0.616). HIT-6 scores decreased significantly (64.7 ± 3.6 at V0, 64.8 ± 5.0 at V1, and 60.8 ± 5.4 at V2; F[2,148] = 5.63, p = 0.004). DASS-21 subscales showed nonsignificant reductions at 3 months, with exploratory analyses indicating gradual improvements at 6 and 9 months.

CONCLUSION: A short, structured multimodal program in a day-clinic setting significantly improved the mental component of health-related quality of life and reduced headache-related disability in patients with primary headache disorders. Although physical functioning and headache frequency did not change significantly at 3 months, the program provided clinically relevant benefits in coping and mental health. These findings highlight multimodal day-clinic treatment as a valuable component of comprehensive headache care, even in the era of CGRP-targeted treatment options.

PMID:42120316 | DOI:10.1111/head.70133