{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T23:46:26Z","timestamp":1779320786676,"version":"3.51.4"},"reference-count":77,"publisher":"Wiley","issue":"23","license":[{"start":{"date-parts":[[2021,8,6]],"date-time":"2021-08-06T00:00:00Z","timestamp":1628208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["1R01CA239714"],"award-info":[{"award-number":["1R01CA239714"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01CA181659"],"award-info":[{"award-number":["R01CA181659"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Breast cancer survivors often have persisting headache. In a secondary analysis of the Brief Behavioral Therapy for Cancer\u2010Related Insomnia (BBT\u2010CI) clinical trial (ClinicalTrials.gov identifier NCT02165839), the authors examined the effects of BBT\u2010CI on headache outcomes in patients with breast cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with breast cancer who were receiving chemotherapy were randomly assigned to receive either the BBT\u2010CI intervention or the Healthy EAting Education Learning for healthy sleep (HEAL) control intervention, and both were delivered over 6 weeks by trained staff. Headache outcomes and heart rate variability (HRV) were measured at baseline, 6 weeks, 6 months, and 12 months. Mixed\u2010effects models were used to examine longitudinal headache outcomes in the groups according to the intention to treat. Principal component analysis and agglomerative hierarchical clustering were conducted to reduce 16 variables for data\u2010driven phenotyping.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients in the BBT\u2010CI arm (n = 73) exhibited a significant reduction in headache burden over time (<jats:italic>P<\/jats:italic> = .02; effect size [Cohen d] = 0.43), whereas the reduction was not significant among those in the HEAL arm (n = 66). The first principal component was positively loaded by headache, sleep, fatigue, and nausea\/vomiting and was negatively loaded by cognitive, physical, and emotional functioning. Agglomerative hierarchical clustering revealed 3 natural clusters. Cluster I (n = 58) featured the highest burden of headache, insomnia, and nausea\/vomiting; cluster II (n = 50) featured the lowest HRV despite a low burden of headache and insomnia; and cluster III (n = 31) showed an inverse relation between HRV and headache\u2010insomnia, signifying autonomic dysfunction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>BBT\u2010CI is efficacious in reducing headache burden in breast cancer survivors. Patient phenotyping demonstrates a headache type featuring sleep disturbance, nausea\/vomiting, and low physical functioning\u2014revealing similarities to migraine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Lay Summary<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>Breast cancer survivors often have persisting headache symptoms.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>In patients with cancer, treatment of chronic headache disorders using daily medications may be challenging because of drug interactions with chemotherapy and other cancer therapies as well as patients' reluctance to add more drugs to their medicine list.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Headache and sleep disorders are closely related to each other.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>This study demonstrates that a sleep behavioral therapy reduced headache burden in breast cancer survivors.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>In addition, the majority of headache sufferers had a headache type with similarities to migraine\u2014featuring sleep disturbance, nausea\/vomiting, and low physical functioning.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.33844","type":"journal-article","created":{"date-parts":[[2021,8,6]],"date-time":"2021-08-06T09:16:05Z","timestamp":1628241365000},"page":"4492-4503","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Headache outcomes of a sleep behavioral intervention in breast cancer survivors: Secondary analysis of a randomized clinical trial"],"prefix":"10.1002","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4879-6098","authenticated-orcid":false,"given":"Yohannes W.","family":"Woldeamanuel","sequence":"first","affiliation":[{"name":"Division of Headache Medicine Department of Neurology and Neurological Sciences Stanford University School of Medicine Palo Alto California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7931-4533","authenticated-orcid":false,"given":"Douglas W.","family":"Blayney","sequence":"additional","affiliation":[{"name":"Stanford Cancer Institute Stanford University School of Medicine Palo Alto California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Booil","family":"Jo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Palo Alto California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6771-6113","authenticated-orcid":false,"given":"Sophie E.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Stanford Cancer Survivorship Research, Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Palo Alto California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9622-249X","authenticated-orcid":false,"given":"Catherine","family":"Benedict","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Palo Alto California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingrid","family":"Oakley\u2010Girvan","sequence":"additional","affiliation":[{"name":"The Data and Technology Proving Ground Public Health Institute Oakland California"},{"name":"Medable Inc. 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