Table 5 Participant responses to being asked about their experience of and impact from specific group sessions

Session 1&2. Welcome & Introduction

No specific comments on these

Session 3*. Headache information and mechanisms n = 14

7 gained new information about characteristics and classification of different headaches

7 were previously aware of medication overuse headache (MOH). Of these, 2 thought it relevant to them but were resistant to decreasing medication and 1 thought it not relevant for them

7 were unaware of MOH and were either surprised or found it counter intuitive. Of these, 4 decided to change their medications, 1 came off their medication altogether, 1 was resistant to decreasing their medication, 2 thought it not relevant for them

Session 4*. Acceptance of chronic headaches n = 12

10 participants found it useful and relevant to living with headaches, “...helps you to think slightly differently about things.” 23

6 participants recognised where they were on the acceptance curve: “That’s kind of been me!.....that has stuck with me…“15 “I’m past the phase of ‘Why me?”‘09, “I’m definitely at the acceptance stage…“23

3 didn’t find this session useful “I found that [acceptance session] bizarre.”24

Relaxation and breathing n = 13

5 had not used the CD or relaxation after the course

3 used the CD and were continuing to use some form of relaxation.

2 used their own established form of relaxation

3 had no time to fit relaxation into their lives

2 thought they did not need relaxation as they were not stressed

Session 5. Impact of thoughts, mood and emotions on headaches n = 11

11 agreed there was a strong link between mood and headache of which 1 did not understand session aim and content as found delivery unclear

Session 6*. Headache cycle and breaking the cycle n = 10

6 thought it useful to look at headaches in a different way

3 thought headache cycle was easier said than done

3 did not feel it was personally relevant

Session 7*. Unhelpful thinking patterns: recognising and finding alternatives n = 12

5 identified with unhelpful thinking, “… we were able to identify things that we were doing and everyone was going ‘oh yeah yeah’…“31

5 changed their thinking to be more positive using the reframing techniques taught

“that was quite interesting actually it was like actually ‘turn your thoughts around and think well what can I do……is there anything I can do to help myself?’ So that was really good.” 30

3 had heard about the technique before of which 1 did not get on with it

4 did not find it useful, 1 said it had not been explained well enough

1 decided to see their GP about antidepressants due to this session.

Educational DVD n = 15

11 had watched the DVD of which four watched with someone else (a relative or friend) and found this useful. Of those who had watched it, 5 found it personally useful, 4 already knew the content and 2 had no memory of the content

4 had not watched the DVD of which 2 had no way to play it

Session 10*. Identifying barriers to change and exploring problem solving and goal setting n = 12

4 already knew about goal setting

7 found goal setting useful: increasing their fluid intake (2) decreasing or changing their medication (2) doing mindfulness (1) or increasing their practice, (1) and improving their bedtime routine to help their sleep quality (1). Of these 3 had achieved their goals, 3 had not and for 1 it was work in progress

5 found goal setting was ‘not for them’ (2), difficult (2) or provoked anxiety (1)

Session 11. Lifestyle factors and impact on headaches n = 13

All found this useful “…to understand what it is you are actually doing and see if there is a link and a connection to the headaches...” 09

Session 12*. Managing stress and anxiety n = 10

All acknowledged link between stress and headaches but for most doing something about it was difficult

3 had considered making or made changes. “My job is a very stressful … when I asked they did reduce some of the job for me…… even just going for a walk it can help you reduce it [stress] but before I didn’t really know that.” 24

Session 13. Managing sleep better n = 10

4 said they slept well and 2 found the information helpful. 4 were already aware of the information and for one shift work was a problem, “It wasn’t anything that I didn’t know already … it is very, very difficult because of shift work…” 31

Session 14*. Mindfulness and relaxation for headaches n = 17

3 were using mindfulness successfully: 1 already practised it, 1 restarted it and 1 commenced it

3 used mindfulness informally “But you see if I pick that cross stitching up I can’t think of anything else but that while I’m doing it so my mind’s completely blank from anything else and I think that helps me.”28

8 found it not personally useful: 4 because focusing increased other symptoms of stress, pain or headache; 4 did not understand what mindfulness was and 4 had no time in their lives to try it

Session 15*. Medication management n = 10

9 liked hearing about the different medications available for migraine. “I mean I’ve had migraines for years and no one’s ever suggested this before” 31 of which 2 used the information to discuss medication with their doctor.

2 wanted more in-depth personally tailored information

Session 16. Relationships and communication with family, carers and friends n = 4

3 found the listening exercise enjoyable

1 found it irrelevant

Session 17*. Communicating better with Health Professionals n = 9

4 found the role play helpful: “When I was first going in [to doctors] with my headaches it was like, ‘Well just keep taking Paracetamol’, ‘Well it’s not doing anything’ … so it was quite good to actually go in and be like ‘right ok doctor I want to be put on a preventative I can’t live with my headaches like this’… really helpful.” 30

4 did not find it personally useful

1 thought it not useful “if they’re [doctor] not gonna listen you are not gonna get anywhere… a lot of times they need to learn their bedside manner”17

Session 18. Managing setbacks – what to do when things don’t go to plan n = 7

All 7 remembered little about the session except it rounded off the course and that setbacks are part of life.