Yoga for Pediatric Tension-Type Headache

Adolescents (ages 13 to 18) with TTH will be randomly assigned to either a Hatha yoga intervention (n = 20) or a wait-list control condition (n = 20). The yoga intervention will consist of 8 weekly classes lasting one hour each taught by an experienced yoga teacher. Each class will have a maximum of 10 participants. A baseline assessment including an experimental pain protocol, questionnaires, and hair samples (to determine cortisol concentrations in the past month) will be completed prior to the intervention. Biweekly questionnaires will be completed by both intervention and wait-list groups during the 8-week intervention period. The post-intervention assessment will include the experimental pain protocol, questionnaires, and hair samples (to determine cortisol concentrations in the past month). The wait-list control group will subsequently receive the yoga intervention and complete post-intervention and follow-up assessments (i.e., the wait-list group will complete one more experimental pain protocol and will provide one more hair sample than the intervention group); these data will then be merged with that of the yoga group to examine pre- and post-intervention effects. Both intervention and wait-list groups will complete questionnaires 3 months following completion of the yoga protocol.

Specific Aim 1: To determine the safety, feasibility, and acceptability of an 8-week Hatha Yoga Protocol (HYP) in adolescents (ages 13 to 18) with tension-type headache (CTTH). Hypothesis: At least 80% of adolescents will complete the HYP. Attrition rates will be compared between HYP and control groups to determine whether results may be biased given different durations of the study protocols between the two groups and interval between recruitment and intervention (i.e., control group will be in the protocol for two additional months and the intervention will be delayed by 8 weeks).

Specific Aim 2: To evaluate changes in primary outcomes (frequency and intensity of headaches, pain-related functional disability, health-related quality of life, medication use) from baseline to post-intervention in the HYP and usual care wait-list controls. Hypothesis: Participants in the HYP group will demonstrate greater reduction in headache frequency and intensity, decreases in pain-related functional disability, improvement in health-related quality of life, and reduction in medication use compared to wait-list controls from baseline to post-intervention. Secondary analyses will examine changes from pre- to post-intervention for the entire sample once the waitlist group has completed the HYP; in addition, sustained intervention effects will be determined by examining changes from post-intervention to 3-month follow-up for the entire sample.

Specific Aim 3: To assess changes in potential mediators of clinical outcomes following the HYP, including responses to experimental pain [conditioned pain modulation (CPM), temporal summation to second pain (TSSP)], alterations in stress response systems [hair cortisol concentrations, self-reported stress levels, stress hormone responses to experimental pain (cortisol, alpha-amylase, DHEA), heart rate variability responses to experimental pain] and pain-related cognitions (catastrophizing, self-efficacy, acceptance). Hypothesis: Participants in the HYP group will show increased CPM, decreased TSSP, reduced hair cortisol concentrations and self-reported stress levels, lower cortisol and alpha-amylase responses to experimental pain, higher DHEA responses to experimental pain, lower heart rate variability prior to experimental pain, reduced pain catastrophizing, increased pain self-efficacy, and increased pain acceptance compared to wait-list controls at post-intervention.

Although yoga has shown promise as a complementary health approach for chronic pain in adults, few studies have examined the potential efficacy of yoga for adolescents with chronic pain. Anticipated findings from the proposed study will help to determine whether - and how - an 8-week yoga intervention can improve pain-related outcomes in adolescents with TTH; these findings will be critical for refinement of the HYP for youth with TTH and for the design and implementation of a larger-scale, randomized controlled trial with an active control condition.