The Promise of Mechanistic Approaches to Understanding How Youth with Migraine Get Better—an Editorial to the 2020 Members' Choice Award Paper

Our team is honored to receive the 2020 Members' Choice Award for our paper “Alterations in brain function after cognitive behavioral therapy for migraine in children and adolescents”.1 This study is the first to assess the neural mechanisms underlying this nonpharmacological therapy in children and adolescents with migraine. Cognitive behavioral therapy (CBT) is a nonpharmacological therapy that is effective in reducing pain (and associated disability) in various patient populations with chronic pain, including migraine.2,3 In combination with amitriptyline, CBT is the highest recommended therapy from the American Headache Society and American Academy of Neurology's recent guidelines on the prevention of headache in children and adolescents with migraine.4 Even though CBT is an effective treatment for pain, many patients and physicians are hesitant to use CBT and instead choose to use pharmacological preventive therapies alone. Issues such as lack of awareness and lack of confidence in the efficacy of CBT, stigma of “mental health,” low number of trained providers (similar to the deficit of headache specialists themselves), lack of a welldesigned health delivery system of care (unlike our omnipresent system for picking up a medication prescription), and access barriers are some of the factors that can lead to lack of prescription of this proven treatment.5– 7