[show abstract][hide abstract] ABSTRACT: Patients with chronic headache and medication overuse are particularly difficult to treat, with no one approach being universally accepted. Some type of withdrawal program, however, is typically implemented before beginning a pharmacological prophylaxis treatment. Different withdrawal modalities have been performed for managing these patients: at first step, in-patient withdrawal has been confirmed effective in preceding clinical experiences. In recent years, new modalities for withdrawal have been developed as day-hospital setting. Purpose of this study was to determine the clinical course of a sample of chronic migraine patients with medication overuse 3 years after day-hospital withdrawal. A group of 202 patients were treated. Patients were suffering from chronic migraine with medication overuse according with IHS criteria. All patients were submitted to a day-hospital withdrawal and then they were followed with meetings every 3 months until the first year and then every 6 months until the last follow-up 3 years after withdrawal. Eighty patients achieved the last follow-up meeting 3 years after withdrawal. Patients clinically improved, significantly, both for days of headache per month and consumption of medications per month. From these results, the day-hospital setting for withdrawal, followed by periodic clinical meetings, seems to be effective for this category of patients to improve significantly at long-term headache frequency and analgesics intake.
[show abstract][hide abstract] ABSTRACT: The Association for Behavioral and Cognitive Therapies initiated an interorganizational task force to develop guidelines for integrated education and training in cognitive and behavioral psychology at the doctoral level in the United States. Fifteen task force members representing 16 professional associations participated in a yearlong series of conferences, and developed a consensus on optimal doctoral education and training in cognitive and behavioral psychology. The recommendations assume solid foundational training that is typical within applied psychology areas such as clinical and counseling psychology programs located in the United States. This article details the background, assumptions, and resulting recommendations specific to doctoral education and training in cognitive and behavioral psychology, including competencies expected in the areas of ethics, research, and practice.
[show abstract][hide abstract] ABSTRACT: Migraine and tension-type headache are common clinical problems, occurring even at a young age. When patients report headache as a symptom, it is necessary to exclude a secondary headache induced by an organic disease. Proper diagnosis and management of headache depends on a thorough history review and comprehensive clinical examination. A Chiari malformation is one organic cause that should not be overlooked. A thorough clinical screening is always recommended, including a complete neurological, mental status and physical examination. However, when the symptom pattern suggests a Chiari malformation, neuroimaging is warranted to identify correctly the pathologic condition and the most appropriate therapeutic approach. This paper reviews this condition, the signs and symptoms suggestive of its presence and how to arrive a the proper diagnosis.
Current Pain and Headache Reports 05/2012; 16(4):350-3. · 1.67 Impact Factor
[show abstract][hide abstract] ABSTRACT: Behavioral treatments (predominantly biofeedback, relaxation, and cognitive-behavioral) have been utilized in headache management for many decades. Although effective, they have not been as widely implemented as desired, chiefly due to their time-intensive nature, special therapist qualifications, and patient costs. This paper focuses on ways to make these treatments more affordable and more readily accessible to patients. Various alternative delivery models have been explored. This paper reviews progress to date on three such approaches for treating recurrent headaches in adults--prudent limited office contact, Internet delivery, and mass media approaches. Clinical outcomes, advantages, and disadvantages of these approaches are reviewed in brief.
[show abstract][hide abstract] ABSTRACT: This study examined the combined effects of methylphenidate (MPD) and response cost and token strategy (RCT), administered in an intensive ADHD Summer Camp Training (ASCT) format, on neuropsychological functions. Forty children with ADHD were randomly assigned to either the ASCT treatment (MPD plus RCT) or a control group (MPD plus a 1-hour session of standardized parental education/counselling [SPC]). This latter group was structured to be similar to the more typical current treatment. The ASCT treatment was administered for 2½ weeks and included RCT, consisting of elements of social skill training, attention training, and sports participation. RCT was systematically applied in all daily situations and activities. Executive functions and state of regulation using the Test for Attention Performance (TAP) and the Trail-Making Test (TMT) were assessed before training and at a 6-month follow-up. Participants receiving the ASCT improved specific neuropsychological functions in attention regulation and inhibitory control tasks at the 6-month follow-up. No changes occurred for participants assigned to the control condition. The data suggest that an intensive multimodal summer camp treatment program including strategies of instrumental learning can lead to substantial and enduring improvements in neuropsychological functioning of children and adolescents with ADHD.
[show abstract][hide abstract] ABSTRACT: Objectives: This study assessed the validity and reliability of the Visual Analog Mood Scales (VAMS) when administered to a non-English-speaking, headache population. Methods: The VAMS and another frequently administered measure of mood, the Profile of Mood States (POMS), were administered to sixty patients at a headache clinic in Milan, Italy. The VAMS and POMS were both administered before and after a regularly scheduled appointment at the clinic. Multitrait-multimethod analyses were conducted to assess the validity of each subscale comprising the VAMS. Results: All subscales comprising the VAMS possessed high test-retest reliability, and the "confused,"sad,"angry,"energetic," and "tired" subscales of the VAMS were shown to be valid when administered to a non-English-speaking pain population. Further, compared to age-matched controls (from available normative data), pain patients reported being significantly more confused, sad, and tense on the VAMS and significantly more tired, confused, depressed, and tense on the POMS. Discussion: Given the evidence of strong reliability and validity, the VAMS may be useful as a clinical diagnostic tool when administered to non-English-speaking pain populations.
[show abstract][hide abstract] ABSTRACT: OVERVIEW: People with intellectual or developmental disabilities suffer from the same chronic diseases and conditions as the general population but are more likely to have physical and psychological comorbidities. This places them at higher risk for experiencing pain and for having more frequent or severe pain. Self-report is the gold standard in pain assessment; but people with intellectual or developmental disabilities often cannot provide self-reports. Pain assessment in this population is therefore challenging. People with intellectual or developmental disabilities are increasingly being moved from institutions into community-based settings. Therefore, nurses in all settings need to be knowledgeable about alternate pain assessment methods. This article provides an overview of pain and pain assessment in this population, summarizes the relevant clinical research, and describes one facility's approach to pain assessment of its patients.
The American journal of nursing 12/2010; 110(12):28-35; quiz 36-7. · 0.69 Impact Factor
[show abstract][hide abstract] ABSTRACT: OPINION STATEMENT: There are a variety of nonpharmacologic treatments for headache. Educating patients about headache and its management, identifying and managing triggers (via diaries), modifying lifestyles, and understanding the importance of adopting and adhering to interventions (either pharmacologic or nonpharmacologic) are relevant to all persons with headache. In addition, specific nonpharmacologic treatments can be used either alone or in conjunction with ongoing pharmacologic intervention. Strong candidates for nonpharmacologic treatment include individuals with significant headache-related disability, comorbid mood or anxiety disorders, difficulty managing stress or other triggers, medication overuse, and patients who prefer a specific treatment. Behavioral treatments (relaxation, biofeedback, and cognitive-behavioral therapy) possess the most evidence for successful headache management. They have a long history of randomized trials showing efficacy and are considered first-line preventive options. Among complementary and alternative treatments, recent positive findings from randomized trials using acupuncture provide evidence of its potential as a first-line intervention. Other complementary and alternative techniques do not have a consistent base of research to recommend them for headache prevention, but they may be used if the patient prefers this approach or when other first-line interventions (nonpharmacologic or pharmacologic) have not provided adequate results. Among "natural" treatments, both butterbur extract and vitamin B2 have shown efficacy in more than one randomized trial and are thus potentially useful first-line preventive interventions.
Current Treatment Options in Neurology 11/2010; 13(1):28-40. · 1.94 Impact Factor
[show abstract][hide abstract] ABSTRACT: During hypnosis, the authors tested repeated weight-related, literal and metaphorical suggestions about the heaviness of the subjects' arms. The purpose was to determine if linguistically varied hypnotic suggestions produced significantly different motor reactions--involuntary pressure forces of the forearms--as assessed by a linguistic biomechanical system. Classic, literal (L) suggestions such as "your right arm is heavy" were used, as well as metaphorical (M) suggestions, such as "your right arm is made of lead." A specific effect on the progressive increase of pressure forces only in the temporal sequence L-M for each forearm (literal suggestions followed by metaphorical suggestions) was found. This effect, termed crescendo image metaphor effect, conceptualized within context-limited simulation theory, explains the findings.
International Journal of Clinical and Experimental Hypnosis 07/2010; 58(3):350-65.
[show abstract][hide abstract] ABSTRACT: Biofeedback-related approaches to headache therapy fall into two broad categories: general biofeedback techniques (often augmented by relaxation-based strategies) and methods linked more directly to the pathophysiology underlying headache. The use of general biofeedback-assisted relaxation techniques for headache has been evaluated extensively by expert panels and meta-analyses. Taken together, these reviews indicate that (1) various forms of biofeedback are effective for migraine and tension-type headache; (2) outcomes with biofeedback rival outcomes with medication therapy; (3) combining biofeedback with medication can enhance outcomes; and (4) despite efficacy in many patients, biofeedback fails to bring significant relief to a sizeable number of headache patients. Biofeedback methods that more directly target headache pathophysiology have focused chiefly on migraine. These headache-specific approaches include blood volume pulse biofeedback, which has considerable supportive evidence, and electroencephalographic feedback.
Cleveland Clinic Journal of Medicine 07/2010; 77 Suppl 3:S72-6. · 3.40 Impact Factor
[show abstract][hide abstract] ABSTRACT: The high prevalence of headache in young age has a significant impact on patients and their families. Migraine and tension-type headache are the most common forms of headache for which young patients see a physician. Recent studies confirm the increasing incidence of migraine and also chronic migraine in the pediatric population. The article reviews the most important diagnostic categories of headache in young age and the limitations of the classification criteria for this group of patients.
[show abstract][hide abstract] ABSTRACT: Headache is one of the commonest conditions to affect children and adolescents in industrialized countries. Effective pharmacological treatments without side effects are still lacking. Ginkgolide B, an herbal constituent extract from ginkgo biloba tree leaves, is a natural antiplatelet activating factor (PAF). PAF is a potent proinflammatory and nociceptive agent released during the inflammation process. Therefore, Ginkgolide B can be considered a promising non-pharmacological tool for treatment of migraine with and without aura. We propose to determine the efficacy of Ginkgolide B as preventive treatment in a group of young patients suffering from migraine without aura. A small sample of 24 young patients suffering from migraine without aura entered the open-label prospective trial. Migraine without aura was diagnosed according to International Headache Society criteria. The treatment was well tolerated and the compliance was good. These preliminary data show that Ginkgolide B seems to be effective as preventive treatment in reducing migraine attack frequency and in attenuating the use of symptomatic medication in our small series of children with primary headache.
[show abstract][hide abstract] ABSTRACT: Chronic migraine with symptomatic medication overuse (CMwMO) is a common and often debilitating clinical condition. Withdrawal of the offending drug(s) is considered the first step in management. Functional magnetic resonance imaging (fMRI) may be a useful technique for obtaining information on particular neuronal changes in the pain network involved in this condition.
To identify specific fMRI patterns in patients suffering from CMwMO before and after withdrawal intervention.
We collected fMRI data from a group of patients suffering from CMwMO, evaluating those patients prior to and 6 months following withdrawal. We applied stimuli at sites far removed from where the headaches were experienced. Moreover, pre-intervention fMRI data from the headache patients were compared with those obtained from headache-free and otherwise healthy controls.
Before withdrawal, the right supramarginal gyrus, the right inferior and superior parietal cortex were hypoactive. Activity recovered to almost normal 6 months after withdrawal of the offending medications.
The hypoactivation we detected in the lateral pain system indicate that there exists a modification of the pain network in CMwMO and that these changes are reversible with therapy.
Headache The Journal of Head and Face Pain 06/2010; 50(6):998-1004. · 2.94 Impact Factor
[show abstract][hide abstract] ABSTRACT: Although behavioral approaches cannot be seen as offering a panacea for all emotional ills, the assumption upon which they are based make their integration with physiological concepts a natural and comfortable union. The application of behavioral treatments for psychosomatic disturbances has been developed in the last 30 years favouring the organization of clinical protocols of treatment more standardized and scientifically proved in particular in headache field where the behavioral approach is actually an important therapeutical support for traditional pharmacological approaches. The different therapeutical approaches, initial outcomes are discussed.
[show abstract][hide abstract] ABSTRACT: Several meta-analyses have demonstrated that the combination of electrical muscle activity and Temperature Biofeedback could be regarded as gold standard in chronic pediatric headaches. However, these techniques seem to be uneconomical and furthermore they are not directed to improve the social competence as well as resolve possible impairments in daily activities of the child. Therefore, multi-modal behavioral techniques have been proposed, but no studies comparing these with the gold standard were conducted. The present study compared the impact of a new multi-modal behavioral education and training program--MIPAS-Family--with a combined Biofeedback treatment, evaluating clinical efficacy as well as the effect on the quality of life (QoL) of children with chronic headaches. Thirty-four children and adolescents with recurrent headache, ranging from 7 to 16 years, were randomly assigned to the MIPAS-Family (N = 19) or the Biofeedback (N = 15) condition. All patients were diagnosed by the criteria of the International Headache Society. The children and their parents completed headache diaries, diaries of daily living activities and a QoL questionnaire (KINDL). Both groups showed significant improvements concerning the headache intensity and headache duration. We found no significant differences in the main headache parameters between both treatments. After the treatments, the children were less disturbed by their headaches in the domains school, homework, and leisure time. In conclusion, MIPAS-Family is as effective as Biofeedback but it is more cost-effective and addresses the whole family and the daily activities.
The Journal of Headache and Pain 04/2010; 11(3):215-25. · 2.78 Impact Factor
[show abstract][hide abstract] ABSTRACT: Primary headaches, including migraine and medication overuse headache (MOH), can be conceptualized as biobehavioral disorders based on the interaction of biological, psychological, and environmental factors. This article reviews empirically supported and efficacious behavioral approaches to the treatment and management of headaches in general, with an emphasis on migraine and MOH from a biopsychosocial perspective. Evidence-based behavioral medicine treatments for migraine and MOH are reviewed, including patient education, cognitive behavioral therapy, and biobehavioral training (biofeedback, relaxation training, and stress management). Information regarding psychological comorbidities and risk factors for progression of migraine and the development of MOH is also reviewed. Strategies are provided for enhancing adherence and motivation, as well as facilitating medical communication.
Current Pain and Headache Reports 07/2009; 13(3):241-8. · 1.67 Impact Factor
[show abstract][hide abstract] ABSTRACT: Chronic migraine accompanied by medication overuse is particularly difficult to treat. The number of treatment investigations is limited, few have included follow-up beyond 6 months and almost none has examined whether treatment leads to concurrent improvements in disability and functional impairment. This open-label study addresses these limitations. We have been prospectively following an initial cohort of 84 chronic migraine patients with medication overuse, who at the time of this evaluation had been reduced to 58, for an extended period to assess longer-term maintenance of effects, using measurement procedures identical to those in the original investigation. Thus, the specific aim was to determine the clinical status, with respect to pain indices and disability level, of chronic migraine patients with medication overuse who were treated and followed prospectively for 5 years. All patients completed a brief inpatient treatment programme, in which they were withdrawn from their offending medications and subsequently placed on more appropriate preventive antimigraine medications. Both end-point, wherein missing data points were estimated, and continuer analyses, wherein data analysis was limited to the 58 individuals with complete datasets, revealed significant improvement on all measures studied-headache days per month, analgesic consumption and Migraine Disability Assessment (MIDAS) total score. The percentage reduction from baseline to 5 years for the MIDAS total score was 76.0%, while the percentage of individuals revealing improvements of clinically significant magnitude (≥ 50%) on the MIDAS was 91.9%. MIDAS total scores were lower at 5 years than at some of the intervening follow-up intervals. Comparisons of those who completed the 5-year follow-up (n = 58) with those who did not revealed no differences at baseline. This finding, coupled with the nearly identical results for the end-point and continuers analyses, suggests that attrition did not have a bearing on outcome. None of the patients completing the 5-year follow-up had relapsed since the prior 3-year follow-up assessment. High levels of maintenance were revealed at 5 years, with disability scores showing some continued improvement over time. The implications of these findings and the limitations of the study are discussed.
[show abstract][hide abstract] ABSTRACT: Behavioral medicine is based on the biopsychosocial theory that biological, psychological, and environmental factors all play significant roles in human functioning. This article reviews empirically supported and efficacious behavioral approaches to the treatment and management of migraine including cognitive behavioral therapy and biobehavioral training (ie, biofeedback, relaxation training, and stress management). These techniques have demonstrated efficacy when learned and practiced correctly and may be used individually or in conjunction with pharmacologic and other interventions. Data are also reviewed regarding patient education, support groups, psychological comorbidities, modifiable risk factors for headache progression, strategies for enhancing adherence and motivation, and strategies for effective medical communication.