Complementary Effect of an Educational Website for Children and Adolescents with Primary Headaches in Tertiary Care: A Randomized Controlled Trial

Abstract

Background/Objectives: Tension-type headache and migraine are common among children and adolescents, often causing significant distress and persisting into adulthood. While outpatient pain therapy is essential, it is not always sufficient. To enhance initial therapy consultations, we evaluated a new educational website in a pediatric outpatient pain clinic. Methods: Ninety-three children with headache (M_age = 12.66, SD_age = 2.86) visiting a specialized tertiary care center were randomly assigned to either an intervention or control group. The intervention group received immediate access to the website, while the control group was given access after the final assessment. Three online follow-up assessments occurred at four-week intervals after baseline. Recruitment occurred between April 2021 and October 2022. Results: Headache-related disability, headache days, and days with headache medication use significantly decreased over time (main effect; disability: β = -0.23, 95%-CI = [-0.36; -0.09], p = 0.001; days: β = -0.18, 95%-CI = [-0.32; 0.03], p = 0.018, medication: β = -0.16, 95%-CI = [-0.31; -0.02], p = 0.026). No statistically significant changes were observed for average headache intensity, passive pain coping, positive self-instructions, seeking social support, pain self-efficacy, and headache-related knowledge. Groups did not differ in their improvement over time (interaction effect). Per-protocol analysis yielded a similar trend: headache-related disability improved significantly with no interaction effects. Despite the limited impact on headache management, children rated the website as relevant and easy to understand. Conclusions: While well-received, the website's effectiveness may have been limited by participants' prior knowledge, concurrent therapies, and low engagement. Future research should focus on better integrating the tool into treatment plans, optimizing usage, and tailoring content to varying knowledge levels. Nevertheless, it shows potential as a long-term self-management tool.

Keywords: digital health; headache; health communication; multi-level analysis; outpatients; pediatrics; web browser.

Figure 1

Flowchart. T1, T2, T3 and T4; First, second, third, and fourth assessments. Partly completed: IG: n_T1 = 2, n_T2 = 3, n_T4 = 2. CG: n_T3 = 2. T1 data of two children were removed from T1, as they answered the questionnaire after their appointment.

Figure 2

Mean trajectories of outcomes stratified by group (intervention vs. control group). Assessments occurred before the appointment (T1), and 4, 8, and 12 weeks after T1 (T2–T4). Error bars represent 95% confidence intervals. N = 93.

Figure 3

Utilization of and satisfaction with the website at the second assessment (T2) by group (presence vs. absence of a migraine diagnosis). Circle: migraine diagnosis (n = 12); Square: no migraine diagnosis (n = 11).