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Study neurologists remained blind to randomization condition throughout the study. Chances of unblinding were limited because follow-up appointments with the study neurologist were scheduled for 3 months following the initial assessment. Further, all interim phone contacts related to medical issues were managed by nurses who were not directly affiliated with the research study. Following the baseline period, participants in the wait-list control group continued to submit records weekly while following the recommendations of their neurologist. Such recommendations consisted of medication prescriptions see Table 2 for breakdown of medications prescribed ; and dietary and sleep schedule advice. Participants in the wait-list control condition were contacted weekly to encourage consistent record-keeping and to ensure there was no systematic bias in the level of therapist attention received by both groups. The wait-list period continued for 2 months, at which point children were offered the opportunity to receive the Headstrong program and followed the procedures outlined for the treatment group. Participants in the treatment group continued to follow the recommendations of their neurologist and were sent the Headstrong CD-ROMs immediately following the baseline period. Table I gives an overview of the components covered in the Headstrong program. Participants completed one module per week for 4 weeks education, relaxation, thought-changing, and pain behavior modification ; and were contacted by phone weekly to address questions. Each treatment module covered in the Headstrong program was adapted from interventions found to be efficacious in the pediatric headache literature Hillier & McGrath, 2001 ; . Each lesson on the Headstrong program took an average of approximately 10 min to complete not including home practice each module could thus be completed within approximately 1 hr. The educational module of the Headstrong program consisted of several fully narrated lessons for which the child would click through in a predetermined order over the course of 1 week. The relaxation module consisted of a rationale and subsequent graphic demonstrations and experiential learning of various relaxation techniques deep breathing, imagery, and progressive muscle relaxation ; . For imagery, the child could choose among three different images for experiential learning based on his her preference. The thought-changing module consisted of a rationale and interactive means of demonstrating how to change thoughts about common stressful experiences e.g., academic and social stress as well as headaches ; to more helpful thoughts. Finally, pain behavior modification and cyproheptadine.

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