Effectiveness of an intensive multidisciplinary headache treatment program.

OBJECTIVE: To investigate if the effectiveness of a 96-hour multidisciplinary headache treatment program exceeds the effectiveness of a 20-hour program and primary care. BACKGROUND: When dealing with chronic back pain, low-intensity multidisciplinary treatment yields no significantly better results than standard care and monodisciplinary therapy; however, high-intensity treatment does. For multidisciplinary headache treatment, such comparisons are not yet available. In a previous study undertaken by our Pain Center, the outcome of a minimal multidisciplinary intervention model (20-hour) did not exceed primary care. METHODS: Forty-two patients suffering from frequent headaches (20 +/- 9 headache days/month; range: 8-30) were treated and evaluated in a 96-hour group program. The results were compared with the outcomes of the previous study. Subjects who had undergone either the 20-hour multidisciplinary program or the primary care were used as historical control groups. FINDINGS: A significant reduction in migraine days (P < .001), tension-type headache days (P < .001), frequency of migraine attacks (P = .004), and depression score (P < .001) was seen at the follow-up after 22 (+/-2) weeks. Comparing the intensive multidisciplinary program with primary care, repeated measures ANOVAs revealed significant time x group interactions for migraine days (P = .020), tension-type headache days (P = .016), and frequency of migraine attacks (P = .016). In comparison with the 20-hour multidisciplinary program, the 96-hour program showed significantly better effects only in the reduction of migraine days (P = .037) and depression score (P = .003). The responder-rates (> or =50% improvement) in the 96-hour program were significantly higher than in the 20-hour program (migraine days, P = .008; tension-type headache days, P = .044) and primary care (migraine days, P = .007; tension-type headache days, P = .003; tension-type headache intensity, P = .037). The effect sizes were small to medium in the 96-hour program. Particularly with the reduction of migraine symptomatology, the 96-hour program performed better than the 20-hour program, which produced only negligible or small effects. CONCLUSIONS: Intensive multidisciplinary headache treatment is highly effective for patients with chronic headaches. Furthermore, migraine symptomatology responds especially well to this intensive treatment program, whereas effects on tension-type headaches were realized by both multidisciplinary programs. Randomized controlled trials and subgroup analysis are needed to find out if these results can be replicated and which patient characteristics allow for sufficient improvements for headache sufferers even with less complex treatment.

Weight loss maintenance in a population-based sample of German adults.

The objective of this study was to investigate the prevalence of weight loss maintenance in a population-based sample of the German adult population. German adults were recruited based on the random digital-dialing methodology. Using computer-assisted telephone interviewing, weight loss maintenance was assessed, defined as having intentionally lost at least 10% from maximum weight and having maintained it for at least 1 year at the time of the survey. A total of 2,095 noninstitutionalized adults were randomly selected from all parts of Germany and the data of 957 respondents were included into the analysis. Of those who were at least overweight (BMI >or= 25 kg/m(2)) at their maximum weight, 17.7% reported having maintained a current weight loss of >or=10% of their maximum weight for at least 1 year. Among participants who reported a maximum weight in the obese range (BMI >or= 30 kg/m(2)), 29.7% reported successful 1-year weight loss maintenance. Among at least overweight participants, being younger and female, and having a higher maximum BMI were significant predictors of successful 1-year weight loss maintenance. The results suggest that successful weight loss maintenance is not uncommon in the general population, particularly in formerly obese participants. More should be learned about the strategies that successful weight maintainers use to avoid regaining weight.