ABSTRACT
Headaches may be highly disabling and can have significant direct and indirect costs for the individual, family, and society. Biobehavioral factors are important variables in the assessment and treatment of headache. As a patient's headache frequency and disability increases, comorbid cognitive and behavioral variables may be important treatment considerations in the comprehensive management. This article will discuss various behavioral factors that the headache practitioner should consider when making a headache diagnosis and formulating a treatment strategy. Biobehavioral interventions (e.g., relaxation training, electromyographic training, thermal biofeedback, mindfulness, and cognitive-behavior therapy) and their efficacy will be described and reviewed, but neuromodulation and noninvasive devices are outside the scope of this article.
Subject(s)
Cognitive Behavioral Therapy , Headache , Humans , Headache/diagnosis , Headache/therapy , Relaxation Therapy , Biofeedback, PsychologyABSTRACT
Patients with chronic migraine (CM) headaches present some of the most difficult treatment challenges for headache practitioners. Attention to psychological and behavioral issues become significant treatment considerations as the frequency of a patient's headaches increases, there is increased disability secondary to headaches, and/or there is inadequate response to usually effective treatment. Recent research has identified a variety of risk factors (including medication overuse) that appear to be associated with the escalation of the frequency and severity of migraine headache and are amenable to behavioral (non-pharmacological) treatment. The present article will highlight therapies that may be effective in the treatment of patients with CM headache.
Subject(s)
Cognitive Behavioral Therapy , Migraine Disorders/psychology , Migraine Disorders/therapy , Adolescent , Adult , Chronic Disease/psychology , Chronic Disease/therapy , HumansABSTRACT
To improve understanding of secondary treatment failure in migraine patients, we evaluated 'headache return' as a novel endpoint to assess returning headaches according to their severity, expanding on current standard assessments of overall recurrence or relapse rates, in a six-month observational study of triptan-treated migraineurs. A total of 359 patients (91% female; mean age, 42.5 years) recorded data for 2168 headaches in electronic diaries. Two-thirds of headaches responded to triptan treatment (improved-to-mild or no pain two hours post-dose); 34% of headaches had a pain-free response. By 48 hours post-dose, 19% of all responding headaches returned; 24% of headaches achieving a pain-free response returned, predominantly to mild pain. More severe baseline headache, short duration since diagnosis of migraine, and female gender were associated with increased likelihood of headache return. Treatment satisfaction declined with increasing severity of headache return, demonstrating the value of assessing headache return by severity to fully evaluate its impact.
Subject(s)
Migraine Disorders/drug therapy , Tryptamines/therapeutic use , Adult , Female , Humans , Male , Medical Records , Patient Satisfaction , RecurrenceABSTRACT
Patients with chronic migraine headaches complicated by medication overuse (MO) present some of the most difficult treatment challenges for headache practitioners. Recent research has identified a variety of risk factors (including MO) that appear to be associated with the escalation of the frequency and severity of migraine headache. Management of such patients with medication overuse headaches (MOH) may become more problematic due to co-morbid psychiatric issues common with migraine patients and the patient's reluctance to limit/eliminate "overused" abortive medications. Medication adherence becomes an important treatment concern. The present article will highlight treatment issues that must be considered in the assessment and treatment of patients with chronic migraine and MOH. Case examples will be offered to illustrate the process of the implementation of these strategies.
Subject(s)
Analgesics/adverse effects , Headache Disorders, Secondary/therapy , Migraine Disorders/therapy , Adult , Chronic Disease , Female , Headache Disorders, Secondary/diagnosis , Headache Disorders, Secondary/epidemiology , Humans , Male , Medical Records , Medication Adherence , Middle Aged , Migraine Disorders/diagnosis , Migraine Disorders/epidemiology , Patient Education as TopicABSTRACT
Most clinicians agree that psychological factors are important considerations in the evaluation and treatment of headache patients. There has been a lack of systematic research, however, that has examined the relationship between these variables. Attention to such factors may become a greater concern as the frequency of a patient's headaches increases, there is increased disability secondary to headaches, and/or there is an inadequate response to usually effective treatment. In addition, there is no consensus as to the proper method to assess psychopathology in headache patients.
