Behavioral Treatment for Migraine Headaches

A recently study titled Direct Costs of Preventive Headache Treatments: Comparison of Behavioral and Pharmacologic Approaches appearing in Headache: The Journal of Head and Face Pain, 51 (6): 985 -991, June 2011, and written by Allison M. Shafer et al., finds that treating chronic migraines using inexpensive prophylactic medicines such as beta-blockers or tricyclic antidepressants and behavioral approaches such as relaxation training, biofeedback, cognitive behavioral therapy, and stress management are a low cost and effective treatment option particularly after 1 year of treatment. The authors used a cost minimization analysis and found that after 1 year, the cost of minimal-contact behavioral treatment was cheaper than the least expensive headache treatment medications. Minimal-contact or home based intervention is when a patient sees a therapist for around 3 or 4 visits and  largely practices the behavioral techniques at home through the use of printed materials and audio recordings. For those who would prefer more visits with a therapist the researchers also found that clinic-based behavioral treatment where a therapist is seen in 8 to 12 weekly sessions becomes cost competitive with medications within 6 months and cheaper than most of the medications available for headache prevention within 1 year. The study concludes “While […]

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In Light of the Allegations of Child Sex Abuse at Penn State…

By now I am sure everyone has at least heard that Joe Paterno has been fired as the head coach of the Penn State college football team due to child sex abuse allegations made against one of his former assistant coaches. As discussed a few times on this blog and as indicated as a potential unfortunate risk of having wisdom teeth extracted there is the possibility of being sexually assaulted while under anesthesia to have wisdom teeth removed. As expanded on and discussed at many of the drugs that dentists and oral surgeons give during the surgery can cause in rare instances sexual hallucinations. This means that it is possible for no repercussions and/or loss of license and/or jail time to occur and it can be difficult to distinguish between dreams and actual molestation in the court of law. In one recent case discussed on this blog in 2009, at,  17 women accused an oral surgeon of sexual assault while he was performing surgery on them. The judge ruled that the women “thought” they were sexually assaulted due to the drugs that there were on and that no real sexual abuse occured. In other cases of sexual assault occurring […]

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What to Do about the Fourth Molar: Similar Management Strategies as the Third Molar aka Wisdom Tooth?

So wisdom teeth are also known as third molars but did you know that there are also fourth molars in a small subset of patients? A recent study was performed by the United States at an Air Base in Japan which is currently in press to appear in the Journal of Oral and Maxillofacial Surgery titeld Prevalence and Management of Fourth Molars: A Retrospective Study and Literature Review by Khurram M. Shahzad and Lawrence E. Roth, 2011. In the study conducted 409 patients were referred for a third molar (wisdom teeth) consultation. Two of 227 white patients (0.9%) had a fourth molar and 6 of 94 black patients (6.4%) had a fourth molar. One of the other 84 patients (1.2%) also had a fourth molar. Of these patients with a fourth molar 5 out of 9 (55%) had only 1 fourth molar and 4 out of 9 (45%) had 2 fourth molars. In 7 of the 9 (78%) of the patients the fourth molars were in the maxilla (upper) and in 2 of the 9 patients (22%) the fourth molars were in the mandible (lower). No patients had fourth molars in both the maxilla and mandible. All of the mandibular […]

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Research During Residency for Oral Surgeons?

Earlier this year over the summer an article appeared in the Journal of Oral and Maxillofacial Surgery discussing the attitudes of program directors and residents toward performing research during residency. I commented on this article here A new article has appeared in the Journal of Oral and Maxillofacial Surgery written by Dr. James R. Hupp titled Research During Residency – Should it be Mandated? (vol. 69, pages 2685-2687, 2011). In the article is a discussion of research and whether or not it should be performed by oral surgeons in residency. Dr. Hupp discuses his own experience with research work and then questions if the current accreditation standards require all Oral and Maxillofacial Surgery residents to do research. He says: “Now the question becomes, should our standards require all residents to have the opportunity to conduct research and, in my mind, also to learn how to communicate the findings of their research. This is indisputably important for residents planning an academic career. However, how does conducting research during training benefit a resident planning to enter private or institutional clinical practice? Perhaps many more residents should be exposed to research which, ultimately, might lead them to pursue an academic career.” Dr. Hupp […]

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The Cyberchondriac: Managing the Difficult Patient

There is an interesting series over at QuantiaMD on Managing the Difficult Patient. Presentations are available for viewing as long as you sign up for with your email. One such presentation was originally called The Patient Who Knows too much but has been changed to The Cyberchondriac. Mary Modahl  who is QuantiaMD Chief Communications Officer said after the original title was added  “‘The Patient Who Knows Too Much’ is a very poor title. Certainly a patient can never know too much. In every way, we’re supportive of doctors meeting their patients’ need for care.” Dr. Joseph Scherger, vice president for primary care at Eisenhower Medical Center in Rancho Mirage, California, defines a Cyberchondriac in the presentation: “This is a patient who is on the internet…indiscriminate with the material they are reading…they consider themselves an expert yet often their true medical knowledge is limited…they are pushing you to do things based on their information.” Dr. Scherger takes a jab at Cyberchondriacs and says “…sometimes these patients are very overweight, they are on the internet all the time…” He also says that if a patient is going to bring in a stack of materials from the internet they should send it in […]

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