Feasibility of Emotional Awareness and Expression Therapy Adapted for Headache Disorders at a Tertiary Headache Clinic

ABSTRACT Objective: Chronic headache, including migraine, is often associated with psychiatric conditions and adverse childhood experiences. This study examines the feasibility of Creating Calm (CC), a modified form of Emotional Awareness and Expression Therapy (EAET) that targets the emotional impacts of adversity in headache patients at a tertiary headache center. We also explored changes in headache days, disability, psychosocial well-being and possible mechanisms to plan for a randomized controlled trial. Methods: We conducted a prospective single-arm pragmatic pilot study to evaluate the feasibility of CC delivered as nine weekly group telehealth sessions in a tertiary headache clinic for adults with high-frequency episodic and chronic headache. Continuation of medical treatments was consistent with the pragmatic design. CC integrates education, mindfulness, cognitive and behavioral approaches, with an emotion-focused mind-body approach used in EAET. Feasibility was based on recruitment, retention and adherence measures. Acceptability was measured through participant satisfaction. We also explored changes in headache, psychosocial and mechanism measures before, after, and 2 months post-treatment. Results: Of the 33 participants recruited, 30 (91%) completed at least 7 out of 9 sessions, and 28 (85%) completed surveys. Participants reported satisfaction with the intervention (mean [SD] 47.6 [10.4] out of 60 Satisfaction with Therapy and Therapist Scale-Revised [STTS-R]). Exploratory analyses found a signal of reduction in headache days per month (mean [SD], 20.8 [7.6] to 15.5 [7.8], p = 0.004), disability, depression and improvement in global mental health following intervention. Conclusion: This real-world pilot study supports the feasibility and acceptability of modified EAET for patients with headache, warranting a prospective randomized clinical trial.