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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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Surgical Treatment of Migraine Headaches

Posted on 04. Jul, 2011 by wisdom.

A study published in Plastic and Reconstructive Surgery shows that trigger site surgery may aid in reducing or even eliminating migraine headaches.

100 patients in a study underwent injection of botulinum toxin A (Botox) into up to 4 potential trigger sites. If a trigger site was identified to be effective than surgery was performed in that trigger area in order to decompress nerves and remove muscles.

71 of 79 patients that were evaluated over a 5 year period were observed to have improvement. This meant they had less mean migraine intensity and or less mean migraine duration.

20 of 69 patients (29.0%) reported elimination of migraines and 41 of 69 patients (59.4%) experience a significant decrease.

Surgery is not without risk and neither is injection of botulinum toxin A.  2 patients had hypersensitivity, 2 patients had hyposensitivity, and 2 patients had numbess at their 5 year follow up. This complications occured in the front region. 1 patient had occasional neck stiffness and 2 patients had occasional neck weakness which occurred in the occipital region.

I know from firsthand experience after having an occipital nerve block in attempt to end my 24/7 headache brought on by removing my wisdom teeth that injections into nerve and muscle areas in an effort to reduce headache can just make things worse as also indicated by this study. ( I discuss this more on http://www.teethremoval.com/occipital_nerve_block.html)

Therefore, anyone suffering from any headache condition should of course proceed with caution before having any injection and/or surgical procedure performed.  There are many different types of headache and jumping into any procedure that can just make pain and suffering worse is not well indicated. Even so an injection and/or surgical procedure can aid in helping those who suffer from migraine.

Due to the design protocol of this study there is no way to tell if the botulinum toxin A injection alone would produce similar results to it and the surgery.

Reference: Bahman Guyuron, Jennifer S. Kriegler, Janine Davis, Saeid B. Amini. Five Year Outcome of Surgical Treatment of Migraine Headaches. Plastic and Reconstructive Surgery. vol. 127. no. 2. 2010.

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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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Headache Causes Difficulty Tuning out Visuals

Posted on 14. May, 2010 by wisdom.

A recent study from researchers from Scotland’s Glasgow Caledonian University has come out with implications for headache sufferers. The research suggests migraine sufferers even when they do not have a headache may process visual cues better in an environment with few visual distractions.

The study demonstrated migraine sufferers with auras were the actually the most affected by the addition of visual noise.

This research has practical implications for those who suffer from headache and migraine. It may thus be best to avoid environments with a lot of visual distractions. This can included several TV and computer screens along with loud noises.

D. Wagner, V. Manahilov, G. Loffler, G. E. Gordon, G. N. Dutton. Visual Noise Selectively Degrades Vision in Migraine. Investigative Ophthalmology & Visual Science. 2009; 51 (4): 2294.

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