{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T06:07:39Z","timestamp":1784700459458,"version":"3.55.0"},"reference-count":37,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the effects of a short, structured multimodal day\u2010clinic program on health\u2010related quality of life and disability in patients with primary headache disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although monoclonal antibodies targeting the calcitonin gene\u2010related peptide (CGRP) pathway have substantially advanced migraine prophylaxis, a large proportion of patients remain insufficiently controlled. Residual disability, comorbidities, and contraindications highlight the need for complementary nonpharmacological approaches. Multimodal programs combining medical, psychological, and behavioral strategies have proven effective in chronic pain but remain insufficiently studied in primary headache populations, particularly in the context of modern pharmacological options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this quasi\u2010experimental pre\u2013post study at the neurological day clinic of University of Greifswald, we investigated a 5\u2010day multimodal treatment program delivered by an interdisciplinary team. Patients were recruited between January and July 2021. The intervention comprised medical consultations, psychological therapy, physiotherapy, occupational therapy, structured education, and relaxation training. Patient\u2010reported outcomes were assessed with the Veterans RAND 12\u2010Item Health Survey (VR\u201012; primary end points: mental component summary [MCS] and physical component summary [PCS]), the Depression Anxiety Stress Scales (DASS\u201021), the Headache Impact Test (HIT\u20106), and headache diaries. Assessments were performed during the pre\u2010admission waiting period (V0), at admission (V1), and at 3, 6, and 9\u2009months after treatment (V2\u2013V4). Primary analyses focused on changes from baseline to 3\u2009months, with exploratory analyses for extended follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 92 patients were included, most with migraine (83%). The VR\u201012 MCS improved significantly over time (\n                      <jats:italic>F<\/jats:italic>\n                      [2,162]\u2009=\u20093.23,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.042; nominal), increasing from an estimated marginal mean of 36.9 (95% CI, 33.35\u201340.45) at baseline (V0) to 38.3 (95% CI, 35.54\u201341.06) at V1, and 41.5 (95% CI, 37.55\u201345.45) at 3\u2009months (V2). Focusing on the pre\u2010specified baseline\u2010to\u20103\u2013month contrast, MCS improved from V0 to V2 (mean difference, 4.63; 95% CI, 1.02\u20138.24;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012; Holm\u2013Bonferroni\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>adj<\/jats:sub>\n                      \u2009=\u20090.024). PCS showed no significant changes (\n                      <jats:italic>F<\/jats:italic>\n                      [2,162]\u2009=\u20090.95,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.387), with estimated marginal means of 38.3 (95% CI, 36.13\u201340.47) at V0, 37.7 (95% CI, 35.73\u201339.67) at V1, and 39.0 (95% CI, 36.24\u201341.76) at V2. Headache frequency did not change significantly across V0\u2013V2 (\n                      <jats:italic>F<\/jats:italic>\n                      [2,148]\u2009=\u20090.49,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.616). HIT\u20106 scores decreased significantly (64.7\u2009\u00b1\u20093.6 at V0, 64.8\u2009\u00b1\u20095.0 at V1, and 60.8\u2009\u00b1\u20095.4 at V2;\n                      <jats:italic>F<\/jats:italic>\n                      [2,148]\u2009=\u20095.63,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). DASS\u201021 subscales showed nonsignificant reductions at 3\u2009months, with exploratory analyses indicating gradual improvements at 6 and 9\u2009months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A short, structured multimodal program in a day\u2010clinic setting significantly improved the mental component of health\u2010related quality of life and reduced headache\u2010related disability in patients with primary headache disorders. Although physical functioning and headache frequency did not change significantly at 3\u2009months, the program provided clinically relevant benefits in coping and mental health. These findings highlight multimodal day\u2010clinic treatment as a valuable component of comprehensive headache care, even in the era of CGRP\u2010targeted treatment options.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/head70133-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  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