Dynamics of changes in self-efficacy and locus of control expectancies in the behavioral and drug treatment of severe migraine.

Background: Modification of expectancies (headache self-efficacy and headache locus of control) is thought to be central to the success of psychological treatments for migraine.

Purpose: The purpose of this study is to examine expectancy changes with various combinations of Behavioral Migraine Management and migraine drug therapies.

Methods: Frequent migraine sufferers who failed to respond to 5 weeks of optimized acute migraine drug therapy were randomized to a 2 (Behavioral Migraine Management+, Behavioral Migraine Management-) × 2 (β-blocker, placebo) treatment design.

Results: Mixed models for repeated measures analyses (N = 176) revealed large increases in headache self-efficacy and internal headache locus of control and large decreases in chance headache locus of control with Behavioral Migraine Management+ that were maintained over a 12-month evaluation period. Chance headache locus of control and socioeconomic status moderated changes in headache self-efficacy with Behavioral Migraine Management+.

Conclusions: The "deficiency" hypothesis best explained how patient characteristics influenced changes in of headache self-efficacy with Behavioral Migraine Management.