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Behavioral Treatment for Migraine Headaches

Posted on 12. Nov, 2011 by wisdom.

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 behavioral interventions for headache have been well validated empirically and have garnered increasing acceptance in recent years, these therapeutic modalities are not widely integrated into the clinical management of headache patients. Broadscale integration into mainstream healthcare practice depends greatly upon more systematically addressing access as well as financial and reimbursement barriers associated with this valuable approach to care.”

Of course if money is not much of an issue it may be best to pursue all available options. However, this study is important to help save costs for those in need (and also the entire health system). I personally have experience with behavioral approaches for the treatment of my chronic headache brought on by having my 4 healthy wisdom teeth extracted as discussed on teethremoval.com.  I also have discussed medications I have tried as well. I hope that behavioral approaches for the management of headaches becomes more widely used and may be very useful and cheaper for some.

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Darvon and Darvocet banned in U.S.

Posted on 09. Jan, 2011 by wisdom.

I find it interesting to hear that the drug commonly known as Darvocet and also similarly Darvon has been banned in the U.S. as of November 19, 2010. The formal name of the drug is Dextropropoxyphene and is in the opiod category of drugs.

This ban came by the FDA in response to research that suggests the drug Darvocet can lead to heart problems such as heart arrythmias. The drug is also known to be addictive and is associated with some deaths. It is commonly prescribed in the treatment of pain.

I personally was prescribed darovcet in 2008 in an attempt to treat my chronic 24/7 headache caused by the removal of my wisdom teeth. I took darovcet a few times and spaced out the usage due to the potential addictive nature. However, it was effective in reducing my pain. I didn’t notice any alarming side effects.

The European Medicines Agency recommended that dextropropoxyphene based medicines be outlawed in the European Union in June 2009. Here we are over a year later where the U.S. Food and Drug Administration (FDA) decides to make a similar call in the U.S. and stop the sale of Darvon and Darvocet.

Many patients who have been taking this medication have to discuss with their doctor what they can use as a substitute. It can be difficult to change medications as well. It seems as if Tramadol is the current leading choice for those who need to switch over from Darvon or Darovcet.

I find this case interesting as it could relate to the removal of wisdom teeth. The British National Institute for Clinical Excellence has long argued that there is no evidence to remove disease free impacted wisdom teeth and says to keep them in due to the risks that can occur. It seems to me that a similar call should be made in the U.S. unless evidence surfaces. Unfortunately the U.S. Food and Drug Administration (FDA) won’t step in to the wisdom teeth removal controversy. Even so, the American Public Health Association does have similar recommendations as the British National Institute for Clinical Excellence regarding third molars.

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Childhood Experiences Impact Headache Frequency and Cardiovascular Disease

Posted on 30. Sep, 2010 by wisdom.

Recent research by Gretchen E. Tietjen, MD, of the University of Toledo College Of Medicine, and her colleagues have shown that childhood experiences have an impact on headache frequency and cardiovascular disease experienced once these children reach adulthood.

Specifically Dr Tietjan and her researchers found children who experience maltreatment such as physical abuse, emotional and/or sexual abuse, and/or physical and/or emotional neglect, are more likely to experience frequent headaches as adults. In another study, Dr Tietjan and her researchers found that if migraine suffers’ experienced adverse experiences (as previously mentioned) as children than they were more likely to experience cardiovascular health problems as adults.

“It is clear…that early adverse experiences influence a migraine sufferers’ cardiovascular health in adulthood,” said Dr. Tietjen.

“Earlier studies have linked childhood maltreatment to frequent headaches and migraine,” said David Dodick, M.D., president of the AHS. “The biological underpinnings of this relationship should be a target of future research and clinicians should be aware of and evaluate for this important relationship in order to facilitate appropriate management strategies.  Dr. Tietjen and her teams are pioneers in understanding the relationship between negative childhood experiences and migraine. Now we need to drill even deeper to understand the relationship between migraine, aura status, childhood maltreatment and CV disease risk.”

Source: American Headache Society

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Sleep Deprivation and the Biological Mechanisms of Chronic Migraine Headache

Posted on 24. Sep, 2010 by wisdom.

Scientists from the Missouri State University’s Center for Biomedical & Life Sciences have found new research to suggest sleep deprivation leads to changes in the levels of key proteins that facilitate events involved in the underlying pathology of migraine.

“Previous clinical data support a relationship between sleep quality and migraine,” said Paul L. Dunham, Ph.D. “so we used an established model of sleep deprivation to measure levels of proteins that lower the activation threshold of peripheral and central nerves involved in pain transmission during migraine. We found that REM sleep deprivation caused increased expression of the proteins p38, PKA, and P2X3, which are known to play an important role in initiating and sustaining chronic pain.”

“So little is known about the biological mechanisms that underlie how certain factors trigger a migraine attack,” said David Dodick, M.D., “This is important work and this Missouri State team should be applauded for beginning to shed light on an area desperately in need of investigation.”

While I don’t personally have exactly a migraine, I have had a headache 24/7 since June 2006, 2 days after the extraction of all four of my wisdom. I have noticed, on the few days necessarily when I was in college, that yes sleep deprivation would increase the intensity and pain I felt from my chronic headache. Understanding the biological mechanisms of migraine is of course important in being able to help prevent and treat migraine and potentially other forms of headache like the one I suffer from all the time since my wisdom teeth were removed.

Source: American Headache Society

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TV and Computer Viewing Leads to Physical Pain

Posted on 17. Sep, 2010 by wisdom.

A new  study looking at computer monitor and TV screen viewing has findings I don’t find particularly shocking or surprising by any means. Over 30,000 Nordic teenagers were used in a study published in the  journal BMC Public Health. Torbjørn Torsheim, from the University of Bergen, Norway, and his researchers found that TV viewing, computer use and computer gaming (screen time) were consistently associated with recurrent headaches and back pain.

Torbjørn Torsheim said, “A rising prevalence of physical complaints such as back pain, neck and shoulder pain, and headache has been reported for adolescent populations. Parallel to this, adolescents are spending an increasing amount of time on screen-based activities, such as TV, computer games, or other types of computer based entertainment.”

The study found  little interaction between the type of activity performed while viewing the computer and TV and the associated physical complaints that arise. The one  exception noted by the researchers was of headache in girls, which seemed to be particularly associated with TV viewing and computer use  but no computer gaming. Hence the physical complaints reported by the teenagers is related to the duration and ergonomic aspects of such activity but not to which specific screen was used.

Torbjørn Torsheim also added, “The consistent but relatively weak magnitude of associations is in line with the interpretation that screen time is a contributing factor, but not a primary causal factor, in headache and backache in the general population of Nordic school-aged teenagers.”

The implications of course for this study is that you should be well aware of your posture and monitor how much time you are spending using a TV or computer. Like always exercise is important and just sitting around all day is not healthy.

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