Contact SRH University Heidelberg School of Therapeutic Sciences Maaßstraße 26 69123 Heidelberg Germany Music Therapy in the Treatment of Primary Headache in Adolescents Preliminary Results: Treatment Satisfaction  Chronic pain among children and adolescents is an important public health problem [9]. Primary headache is the most common type in the 11 - 17 year olds in Germany [3]. With regards to a clinical problem so prevalent there is a lack of evidence for the appropriate pharmacological treatment [6] in this age group. A review concluded that psychotherapeutic interventions (e. g. relaxation techniques, biofeedback and CBT) show significant benefits in reducing pain intensity [11]. Listening to music reduces pain intensity levels and opioid requirements in the perioperative setting, although clinical relevance is still unclear [2]. Existing therapy concepts showed significant benefits in the treatment of adult patients with chronic pain [12]. Music therapy was superior to placebo capsules in the treatment of pediatric migraine [8] and might be a promising prophylactic treatment approach. The aim of this study was to adapt an existing music therapy treatment concept for children with migraine [5] for adolescent patients with primary headache and to evaluate its clinical effectiveness and specific techniques under controlled conditions. The study is evaluating the treatment model in 6 sessions, 90 minutes each within 8 weeks in an ambulatory setting (fig. 1). An experimental group (n = 35) is tested against a control group (n = 35) participating in an attention placebo, educational percussion program (constant dose, therapists), questioning specific factors [1, 4, 10]. Patients are randomized to a group after psychiatric diagnostics (KIDDIE-SADS-PL) concerning exclusion from the study in cases of a primary psychiatric disorder or a likewise health impairment. Frequency and intensity of pain is measured by a 8 week daily diary before and after the intervention and again in a 6-months follow-up assessment (see figure 1). Further psychometric scales such as SES (sensory and affective pain scale), SDQ (strengths and difficulties questionnaire) and KIDSCREEN (health related quality of life measures) are used. A music therapy specific questionaire (HZFB) was used to evlauate parents' treatment satisfaction and their impression of usefulness of the treatment. Parents were asked to fill out the questionnaire after 2 sessions (4 hours of treatment), 4 sessions (8 hours of treatment) and 6 sessions (12 hours of treatment).  [1] Butler, SF, Strupp, HH (1986): Specific and nonspecific factors in psychotherapy: A problematic paradigm for psychotherapy research. Psychotherapy: Theory, Research, Practice, Training, Vol 23(1), Spr 1986, 30-40. doi: 10.1037/h0085590. [2] Cepeda MS, Carr DB, Lau J, Alvarez H. Music for pain relief. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004843. [3] Ellert U, Neuhauser H, Roth-Isigkeit A (2007) Schmerzen bei Kindern und Jugendlichen in Deutschland: Prävalenz und Inanspruchnahme medizinischer Leistungen. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS). Bundesgesundheitsbl- Gesundheitsforsch-Gesundheitsschutz 50:711-717. [4] Kelley, SD, Bickman, L, Norwood, E (2010): Evidence-based treatments and common factors in youth psychotherapy. The heart and soul of change: Delivering what works in therapy (2nd ed.). Duncan, Barry L. (Ed); Miller, Scott D. (Ed); Wampold, Bruce E. (Ed); Hubble, Mark A. (Ed), (2010). The heart and soul of change: Delivering what works in therapy (2nd ed.), (pp. 325-355). Washington, DC, US: American Psychological Association, xxix, 455 pp. doi: 10.1037/12075-011. [5] Leins, A. K. (2006) Heidelberger Therapiemanual: Migräne bei Kindern. In: Bolay, H. V., Dulger, A., Resch, F. (Hrsg.): Evidenzbasierte Musiktherapie. [6] Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S (2004) Practice parameter: Pharmacological treatment of migraine headache in children and adolescents: Report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology 63:2215. [7] Lueger RJ (1995) Ein Phasenmodell der Veränderung in der Psychotherapie. Psychotherapeut; 40:267-278. [8] Oelkers-Ax R, Nickel AK, Parzer P, Hillecke, TK, Bolay HV, Fischer J, Bender S, Hermanns U, Resch F (2008) Butterbur root extract and music therapy in the prevention of childhood migraine: An explorative study. European Journal of Pain 12:301-313. [9] Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, et al. Pain in children and adolescents: a common experience. Pain. 2000;87 :51 58. [10] Strupp, HH (1970): Specific vs. nonspecific factors in psychotherapy and the problem of control. Archives of General Psychiatry, Vol 23(5), Nov 1970, 393-401. [11] Trautmann E, Lackschewitz H, Kröner-Herwig B (2006). Psychological treatment of recurrent headache in children and adolescents. A meta-analysis. Cephalalgia 26:1411-1426. [12] Wormit AF, Hillecke TK, Leins AK, Resch F, Bardenheuer HJ (2007) Musiktherapie bei chronischen, nicht-malignen Schmerzen. In: Hillecke TK (Hrsg) Themenheft "Musiktherapie" VTVM 28:100-114. [13] Koenig, J. Kaess, M., Oelkers-Ax, R., Parzer, P., Lenzen, C., Resch, F., Hillecke, T. K. (accepted): Eine musiktherapeutische Intervention bei wiederkehrenden, primären Kopfschmerzen im Jugendalter – Vorstudie. Der Psychotherapeut   The applied treatment model is theoretically based on the phase model of therapeutic change [7] (remoralization, remediation and rehabilitation). It consists of 12 sessions (45 minutes each) and three family councelings. The concept itself is divided into three phases containing three modules of treatment, specific music therapeutic factors and interventions. Within a pilot study two different time models of treatment were tested in clinical practice (compact: 12 sessions within one week vs. standard: 12 weekly sessions over three months). Participants (n = 19) reported the frequency and intensity of headache symptoms in a daily diary over two months before and after therapy. Both alternatives were found to be effective in reducing the pain frequency and intensity - none was significantly superior to the other [13]. Within the study presented, therapists received a special training and got supervision after each session. Every session was video documented for reasons of quality control and manual adherence. Therapy rooms and equipment were standardized.  We like to thank the Else Kröner-Fresenius-Stiftung for funding the main study and the Landesstiftung Baden-Württemberg and SRH Gruppe for financial support during the pilot phase. The study has been approved concerning the Helsinki declaration by positive vote of the ethics committee. By the time of this poster presentation the final results are prepared for publication.   Koenig, J. 1 , Warth, M. 1 , Oelkers-Ax, R. 2 , Parzer, P. 2 , Kaess, M. 2 , Lenzen, C. 2 , Hillecke, T. 1 , Resch, F. 2 1 School of Therapeutic Sciences, SRH University of Applied Sciences, Heidelberg, Germany 2 Department of Child and Adolescents Psychiatry, University of Heidelberg, Geermany Fig. 1: study design Both groups show an average treatment satisfaction (scale 1–10) that is comparable to previous studies [8]. Treatment satisfaction differs between time points of measurement (ANOVA, factor: time) in treatment (F = 10,626, p < .000) and placebo group (F = 11,984, p < .000). LSD post-hoc test shows improvement of treatment satisfaction after session 2 to 4 (p < .05) and 2 to 6 (p < .000). Differences between groups are not statistical significant (session 2: F = .078, p = .781, session 4: F = .165, p = .686, session 6: F = .663, p = .419). Music Therapy is not superior to a dose equivalent placebo treatment in adolescents with chronic primary headache concerning the treatment satisfaction of parents. The analysis of main outcome criteria needs to prove weather there is a difference in clinical effectiveness (in preparation).    *** *** ** ** Fig. 2: treatment satisfaction