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Nonpharmacological treatment for migraine: Incremental utility of physical therapy with relaxation and thermal biofeedback

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Abstract

The identification of musculoskeletal abnormalities in headache patients has led to the incorporation of physical therapy (PT) into treatment programs for chronic headache. The current studies: (i) investigated the efficacy of PT as a treatment for migraine, and (ii) investigated the utility of PT as an adjunct treatment in patients who fail to improve with relaxation training/thermal biofeedback (RTB). PT alone is not effective in reducing headache, with only 14% of subjects reporting significant headache reduction (mean reduction of 15.6% in comparison with 41.3% in RTB). However, PT may have been a useful adjunct, with 47% of a group of 11 subjects who had failed to improve with RTB reporting improvement with the addition of PT. It is recommended that RTB remain the nonmedical treatment of choice for migraine, and that PT may be a useful adjunct for patients who fail to improve after such treatment.

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... Foram selecionados 18 estudos (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) para síntese qualitativa. Os estudos incluíram 2.950 adultos com diagnóstico de diferentes tipos de cefaleia, sendo 2.409 mulheres e 541 homens, cuja idade variou entre 18 e 60 anos. ...
... A população analisada nos estudos foi composta de participantes com cefaleia do tipo tensional, (18-20, 25, 26, 31) cefaleia cervicogênica (20,21,27,28,30,32,34,35) e migrânea. (20,25,26) Um total de três estudos (22,29,33) não definiu o tipo de cefaleia analisado, e um estudo (23) disse que avaliou cefaleias primárias, porém não mencionou quais delas. ...
... Já quatro estudos (20,23,27,34) tiveram alto risco de viés, pois utilizaram métodos inadequados de randomização, como nomes em papéis ou envelopes. Os nove artigos restantes (19,21,22,24,25,(28)(29)(30)(31) não informaram o método de avaliação utilizado, apresentando risco de viés incerto. O sigilo de alocação foi realizado adequadamente, com baixo risco de viés, em apenas dois artigos, (20,33) por meio de envelopes opacos e selados ou em arquivo de computador. ...
Article
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A intolerância aos movimentos, incapacidade do pescoço e alterações nos músculos pericranianos são aspectos que podem interferir durante as crises de migrânea. A presença destes achados tornou a fisioterapia uma modalidade terapêutica alternativa para as cefaleias. Assim, as desordens estruturais e comportamentais musculares podem promover modificações na biomecânica da cabeça e região cervical, bem como limitações na mobilidade cervical no paciente com cefaleia, as quais podem ser tratadas por meio de diferentes modalidades fisioterapêuticas. O objetivo deste estudo foi revisar as publicações mais relevantes sobre o papel da fisioterapia no tratamento das cefaleias, a fim de fundamentar e direcionar o tratamento não farmacológico destes pacientes. Foi feito um levantamento da literatura, entre setembro/2015 e maio/2016, nas bases de dados MEDLINE/ PubMed, LILACS e Cochrane Central Register of Controlled Trials - CENTRAL, buscando ensaios clínicos randomizados e quasi randomizados sobre o tema. Os descritores do MeSH/DeCS utilizados foram: 'cefaleia', 'modalidades de fisioterapia', e seus equivalentes em inglês. Foram identificados 589 artigos, dos quais 19 foram incluídos, segundo os critérios de elegibilidade. De acordo com os resultados dos estudos avaliados, a fisioterapia promove melhora da cefaleia, dos sintomas associados e das disfunções musculoesqueléticas relacionadas. Entre as modalidades utilizadas estão correção postural, mobilização da coluna, alongamento muscular, técnicas de relaxamento, massagem, exercícios ativos ou passivos, entre outras. Devido à baixa qualidade metodológica da maioria dos estudos, são necessários novos ensaios controlados e randomizados, baseados nos critérios diagnósticos da ICHD, utilizando protocolos descritos de maneira mais detalhada e reprodutível, incluindo a avaliação de efeitos adversos.
... Insgesamt 14 Untersuchungen wurden ermittelt, die in . Tab. 1 überblickartig dargestellt werden [21][22][23][24][25][26][27][28][29][30][31][32][33][34]. ...
... Marcus und Kollegen (1998) untersuchten die Wirkung von Physiotherapie auf die Migränesymptomatik und nutzten eine Entspannungsgruppe als Kontrollbedingung. Die PMR stellte sich hier als der Physiotherapie überlegen heraus [31]. In einer 2008 veröffentlichten Arbeit wurde ein Entspannungstraining als Kontrollbedingung zur Überprüfung der Wirksamkeit des sog. ...
... In der Entspannungsgruppe fanden sich nach dem Training Symptomverbesserungen im Sinne einer reduzierten Kopfschmerzintensität. Problematisch an diesen beiden Arbeiten ist, dass die Entspannungstechniken in zu kurzer Zeit vermittelt wurden; innerhalb von 2 Sitzungen bei Marcus et al. [31] und innerhalb von 4 Sitzungen bei D'Souza und Kollegen [32]. In letzterer Untersuchung wurden allerdings vier verschiedene Verfahren erlernt, also pro Entspannungstechnik eine Sitzung. ...
Article
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Seit Anfang der 1970er-Jahre wird die progressive Muskelrelaxation (PMR) nach Jacobson in der Migräneprophylaxe eingesetzt. Hintergrund ist die Annahme, dass Migränepatienten eine erhöhte autonome Aktivierung aufweisen, der man mit systematischer Entspannung entgegensteuern kann. Entspannungsverfahren reduzieren neben dem Aktivierungsniveau auch die zentrale Schmerzverarbeitung, außerdem bewirken entspannende Strategien eine Aktivierung in schmerzhemmenden Strukturen im periaquäduktalen Grau. Metaanalysen zeigen, dass die PMR ebenso wirksam ist wie medikamentöse Verfahren. Ein guter Effekt stellt sich nur dann ein, wenn regelmäßig täglich mindestens 5–25 min geübt wird und ein Transfer der Übungen in den Alltag erfolgt. Diese Übersicht fasst die empirischen Belege für die Wirksamkeit von PMR bei Migräne kritisch zusammen. Es wird ein Mangel insbesondere an aktuellen Studien zur Thematik festgestellt. In einer eigenen Studie mit 50 Migränepatienten und 46 gesunden Kontrollen konnte neben der klinischen Wirksamkeit auch eine Änderung der kortikalen Aufmerksamkeitszuwendung bei der Messung der kontingenten negativen Variation („contingent negative variation“ [CNV]) nachgewiesen werden. Die zuvor erhöhte CNV-Amplitude normalisierte sich bei regelmäßiger Anwendung der PMR bei Migränepatienten. Mit der Übersicht über PMR-Studien zur Migräneprophylaxe und mit der eigenen Studie kann gezeigt werden, dass PMR ein effektives nichtmedikamentöses Verfahren zur Migräneprophylaxe ist und dass neben den klinischen Effekten auch nachweisbare Änderungen der kortikalen Reizverarbeitung im Sinne einer Normalisierung bewirkt werden können.
... Insgesamt 14 Untersuchungen wurden ermittelt, die in . Tab. 1 überblickartig dargestellt werden [21][22][23][24][25][26][27][28][29][30][31][32][33][34]. ...
... Marcus und Kollegen (1998) untersuchten die Wirkung von Physiotherapie auf die Migränesymptomatik und nutzten eine Entspannungsgruppe als Kontrollbedingung. Die PMR stellte sich hier als der Physiotherapie überlegen heraus [31]. In einer 2008 veröffentlichten Arbeit wurde ein Entspannungstraining als Kontrollbedingung zur Überprüfung der Wirksamkeit des sog. ...
... In der Entspannungsgruppe fanden sich nach dem Training Symptomverbesserungen im Sinne einer reduzierten Kopfschmerzintensität. Problematisch an diesen beiden Arbeiten ist, dass die Entspannungstechniken in zu kurzer Zeit vermittelt wurden; innerhalb von 2 Sitzungen bei Marcus et al. [31] und innerhalb von 4 Sitzungen bei D'Souza und Kollegen [32]. In letzterer Untersuchung wurden allerdings vier verschiedene Verfahren erlernt, also pro Entspannungstechnik eine Sitzung. ...
Article
Full-text available
Seit Anfang der 1970er-Jahre wird die progressive Muskelrelaxation (PMR) nach Jacobson in der Migräneprophylaxe eingesetzt. Hintergrund ist die Annahme, dass Migränepatienten eine erhöhte autonome Aktivierung aufweisen, der man mit systematischer Entspannung entgegensteuern kann. Entspannungsverfahren reduzieren neben dem Aktivierungsniveau auch die zentrale Schmerzverarbeitung, außerdem bewirken entspannende Strategien eine Aktivierung in schmerzhemmenden Strukturen im periaquäduktalen Grau. Metaanalysen zeigen, dass die PMR ebenso wirksam ist wie medikamentöse Verfahren. Ein guter Effekt stellt sich nur dann ein, wenn regelmäßig täglich mindestens 5–25 min geübt wird und ein Transfer der Übungen in den Alltag erfolgt. Diese Übersicht fasst die empirischen Belege für die Wirksamkeit von PMR bei Migräne kritisch zusammen. Es wird ein Mangel insbesondere an aktuellen Studien zur Thematik festgestellt. In einer eigenen Studie mit 50 Migränepatienten und 46 gesunden Kontrollen konnte neben der klinischen Wirksamkeit auch eine Änderung der kortikalen Aufmerksamkeitszuwendung bei der Messung der kontingenten negativen Variation („contingent negative variation“ [CNV]) nachgewiesen werden. Die zuvor erhöhte CNV-Amplitude normalisierte sich bei regelmäßiger Anwendung der PMR bei Migränepatienten. Mit der Übersicht über PMR-Studien zur Migräneprophylaxe und mit der eigenen Studie kann gezeigt werden, dass PMR ein effektives nichtmedikamentöses Verfahren zur Migräneprophylaxe ist und dass neben den klinischen Effekten auch nachweisbare Änderungen der kortikalen Reizverarbeitung im Sinne einer Normalisierung bewirkt werden können.
... The two main principles of this technique are the incompatibility of tension and relaxation and the interaction of muscular and mental levels [16]. PMR has been shown to be potent in the prevention of migraine attacks [17][18][19][20][21]; its effectiveness is comparable to pharmacological migraine prophylaxis [22,23]. Thus, Grade A was given to PMR by the United States Headache Consortium [24]. ...
... There was often no accurate description of the relaxation technique taught to the participants. In some studies, PMR was taught within one or two sessions [19,20,25], which is insufficient according to the recommendations of Bernstein and Borkovec [16]. Thus, in contrast to the persuasion of a high effectiveness for PMR in migraine treatment, the empirical basis is not as solid as expected. ...
... The significant interaction terms of time and intervention for both migraine attacks and days with migraine demonstrate that migraine patients benefit from a regular PMR-training having a lower migraine frequency compared to those without relaxation treatment. Thus, we could show a specific migraine-reducing effect due to the elaborate acquisition of PMR relaxation technique which could not be inferred in such a distinct way from previous studies [17][18][19][20][21]. As shown in other studies, migraine frequency even decreased after completion of the treatment [23]. ...
Article
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Background Central information processing, visible in evoked potentials like the contingent negative variation (CNV) is altered in migraine patients who exhibit higher CNV amplitudes and a reduced habituation. Both characteristics were shown to be normalized under different prophylactic migraine treatment options whereas Progressive Muscle Relaxation (PMR) has not yet been examined. We investigated the effect of PMR on clinical course and CNV in migraineurs in a quasi-randomized, controlled trial. Methods Thirty-five migraine patients and 46 healthy controls were examined. Sixteen migraineurs and 21 healthy participants conducted a 6-week PMR-training with CNV-measures before and after as well as three months after PMR-training completion. The remaining participants served as controls. The clinical course was analyzed with two-way analyses of variance (ANOVA) with repeated measures. Pre-treatment CNV differences between migraine patients and healthy controls were examined with t-tests for independent measures. The course of the CNV-parameters was examined with three-way ANOVAs with repeated measures. Results After PMR-training, migraine patients showed a significant reduction of migraine frequency. Preliminary to the PMR-training, migraine patients exhibited higher amplitudes in the early component of the CNV (iCNV) and the overall CNV (oCNV) than healthy controls, but no differences regarding habituation. After completion of the PMR-training, migraineurs showed a normalization of the iCNV amplitude, but neither of the oCNV nor of the habituation coefficient. Conclusions The results confirm clinical efficacy of PMR for migraine prophylaxis. The pre-treatment measure confirms altered cortical information processing in migraine patients. Regarding the changes in the iCNV after PMR-training, central nervous mechanisms of the PMR-effect are supposed which may be mediated by the serotonin metabolism.
... The literature search identified seven RCT on migraine that met our inclusion criteria, i.e., two massage therapy studies [8, 9], one physiotherapy study [10] and four chiropractic spinal manipulative therapy studies (CSMT)11121314, while we found no RCTs studies on spinal mobilization or osteopathic as a intervention for migraine. Methodological quality of the RCTsTable 2 shows the authors average methodological score of the included RCT studies891011121314. ...
... The literature search identified seven RCT on migraine that met our inclusion criteria, i.e., two massage therapy studies [8, 9], one physiotherapy study [10] and four chiropractic spinal manipulative therapy studies (CSMT)11121314, while we found no RCTs studies on spinal mobilization or osteopathic as a intervention for migraine. Methodological quality of the RCTsTable 2 shows the authors average methodological score of the included RCT studies891011121314. The average score varied from 39 to 59 points. ...
... The average score varied from 39 to 59 points. Four RCTs were considered to have a good quality methodology score (C50), and three RCTs had a low score.Table 3 shows details and the main results of the different RCT studies891011121314. ...
Article
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Migraine occurs in about 15% of the general population. Migraine is usually managed by medication, but some patients do not tolerate migraine medication due to side effects or prefer to avoid medication for other reasons. Non-pharmacological management is an alternative treatment option. We systematically reviewed randomized clinical trials (RCTs) on manual therapies for migraine. The RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine. However, the evaluated RCTs had many methodological shortcomings. Therefore, any firm conclusion will require future, well-conducted RCTs on manual therapies for migraine.
... The main forms of management included in the literature are avoidance of migraine triggers, treatment of the acute attack with medications, regular use of preventive medications and physical therapy modalities (19). Marcus et al. (1998), in a study comparing relaxation training:biofeedback (RTB) vs. physical therapy (PT) as an adjunct treatment for those patients in whom there was no improvement with RTB, have pointed out that RTB remained a non-medical treatment alternative and PT was an effective method of improving the effectiveness of RTB (20). ...
... The main forms of management included in the literature are avoidance of migraine triggers, treatment of the acute attack with medications, regular use of preventive medications and physical therapy modalities (19). Marcus et al. (1998), in a study comparing relaxation training:biofeedback (RTB) vs. physical therapy (PT) as an adjunct treatment for those patients in whom there was no improvement with RTB, have pointed out that RTB remained a non-medical treatment alternative and PT was an effective method of improving the effectiveness of RTB (20). ...
Article
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The purpose of the study was to investigate the results of a manual therapy program, composed of hot pack, classical massage and connective tissue manipulation, in 30 female patients with migraine. The treatment lasted for a total of 20 sessions. The subjects were evaluated before and after the treatment and also controlled 6 months after the treatment. The evaluations were consisted of: assessment of pain intensity, frequency, accompanying symptoms (vomiting, nausea, phonophobia and difficulty to concentrate) and number of analgesic drugs used in a month. In comparison with the results of data obtained from the evaluations prior to and after the treatment, statistically significant decreases were determined in pain intensity, frequency, accompanying symptoms and number of analgesic drugs used in a month (p < 0.01). Also these effects were found to be maintained during a photophobia, period of 6 months after the treatment, when compared to the post-treatment evaluation results (p > 0.05). In conclusion, a manual therapy program composed of hot pack, classical massage and connective tissue manipulation was found to be associated with positive changes in patients with migraine.
... • There are insufficient clinical data to recommend for or against the use of exercise alone or exercise combined with multimodal physical therapies for the management of patients with episodic or chronic migraine (aerobic exercise, cervical range of motion [cROM], or whole body stretching). Three low-quality CCTs 13,33,34 contribute to this conclusion (Table 4). ...
... Practitioners select treatment modalities in conjunction with all available clinical information for a given patient. Of the 16 CCTs/RCTS [11][12][13][14][15][16][17][18][19][20][31][32][33][34][35][36] included in the body of evidence for this CPG, only 6 studies 11,12,15,20,32,36 adequately assessed or discussed patient side effects or safety parameters (Table 1, column M). Overall, reported risks were low. ...
Article
The purpose of this manuscript is to provide evidence-informed practice recommendations for the chiropractic treatment of headache in adults. Systematic literature searches of controlled clinical trials published through August 2009 relevant to chiropractic practice were conducted using the databases MEDLINE; EMBASE; Allied and Complementary Medicine; the Cumulative Index to Nursing and Allied Health Literature; Manual, Alternative, and Natural Therapy Index System; Alt HealthWatch; Index to Chiropractic Literature; and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, limited, or conflicting) and to formulate practice recommendations. Twenty-one articles met inclusion criteria and were used to develop recommendations. Evidence did not exceed a moderate level. For migraine, spinal manipulation and multimodal multidisciplinary interventions including massage are recommended for management of patients with episodic or chronic migraine. For tension-type headache, spinal manipulation cannot be recommended for the management of episodic tension-type headache. A recommendation cannot be made for or against the use of spinal manipulation for patients with chronic tension-type headache. Low-load craniocervical mobilization may be beneficial for longer term management of patients with episodic or chronic tension-type headaches. For cervicogenic headache, spinal manipulation is recommended. Joint mobilization or deep neck flexor exercises may improve symptoms. There is no consistently additive benefit of combining joint mobilization and deep neck flexor exercises for patients with cervicogenic headache. Adverse events were not addressed in most clinical trials; and if they were, there were none or they were minor. Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches. The type, frequency, dosage, and duration of treatment(s) should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal.
... The influence of techniques ameliorating the static and dynamic dysfunctions of the high levels of the cervical region proves the dominant role of the upper cervical spine in the generation of this type of back pain and headache [8][9][10]. We consider that the impact of the upper cervical region is determinant not only for the generation of the so called cervicogenic headache, but too -for the initiation and the aggravation of tension-type headache. ...
Chapter
The purpose of this study is to assess the effectiveness of physical therapy and manual therapy in the treatment and prevention of cervical myofascial pain and headache caused by spinal malposition in smart phone users (abusers). A total of 69 patients with headaches and cervical myofascial pain were under our observation. The patients ranged in age from 19 to 49 years old, had cervical spine posture (position) changes, but no major cervical pathology. For at least six months, all patients used a mobile device in their regular activities (at least two hours per day). Before, during, and after treatment, as well as one month following the conclusion of the rehabilitation, functional evaluation was carried out. We used a comprehensive physical therapy programme on all patients, which included post-isometric relaxation (PIR) for the sterno-cleido-mastoideus and upper trapezius muscles, massages, and analytic exercises for paravertebral muscles, as well as encouraging patients to actively engage in the prevention process (education in principles of back-school, self-massage, auto-PIR). In all patients, we noticed improvements in the cervical spine's static position, less paravertebral muscular spasm, a decrease in the sensitivity of the trigger and tender points, and an increase in the cervical area of the spine's range of active motion. The second group (with manual treatment) produced the most significant results throughout the recovery phase, but a month later, there are no longer any statistically significant differences between the two groups. Physical therapy and manual therapy techniques are particularly helpful for the prevention and recovery phases of headache and cervical myofascial pain. Active (analytic) exercises, PIR and stretching techniques, tractions and mobilizations, patient education, and (in some circumstances) manipulations are all part of the treatment plan. We believe that each physical therapist and medical practitioner who specialises in physical and rehabilitation medicine must modify the general algorithm to meet the demands of the specific patient.
... But Pathophysiology of the disorder is poorly understood (Kewman and Roberts, 1980). Migraine occurs predominantly between the ages of 18-65 year, with peak prevalence at approximately 40 years of age (Kewman and Roberts, 1980;Marcus et al., 1998). Studies have estimated that 12.9% to 17.6% of women and 3.4% to 6.1% of men suffer from migraine. ...
Article
Full-text available
A Migraine is one of the most common disabling headache disorders which is categorized into two broad types based on the number of headache days. It is called episodic or general migraine if the attacks occur less than 15 days per month, and it is categorized as chronic or transformed migraine if headache occur on 15 or more days per month. This study was conducted to ind out the effect of strategy for pain using a modality and strategy using mobilization in reducing disability, frequency and pain in migraine without aura. Thirty-Two subjects were selected based on diagnostic criteria for migraine and divided into two groups. Group A received Cervical Mobilization and Myofas-cial Release with home exercise program and Group B received Transcuta-neous Supraorbital Nerve Stimulation with home exercise program. Visual Analogue Scale, Questionnaire (HIT-6) were recorded as outcome on base-line and after 3 weeks. Results showed signi icant improvements in both the groups with, p<0.01. Between group comparisons elicited non-signi icant differences with p> 0.05. Following the results, it can be concluded that cer-vical mobilization and Transcutaneous Supraorbital nerve stimulation can be added as a valuable adjunct to medical management in the treatment of migraine without aura.
... The influence of techniques ameliorating the static and dynamic alterations of the upper levels of the cervical region proves the dominant role of the upper cervical spine in the generation of this type of back pain and headache [5,6,7]. We consider that the impact of the upper cervical region is determining factor not only for the generation of the so called cervicogenic headache, but too -for the initiation and the intensification of tension-type headache. ...
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Introduction: The introduction of portable devices in the everyday life imposed the necessity to evaluate the possible consequences (of the abuse) on the spine and on the central nervous system, respectively to create programs for the prevention of these consequences. The goal of current article is to evaluate the impact of different physical modalities (including physiotherapy, ergotherapy, manual therapy, deep oscillation, lasertherapy, magnetic field) in the prevention and the complex rehabilitation of the onset of cervical myofascial pain and headache, due to spinal malposition in users (abusers) of smart phones. Material and Methods: We observed a total of 165 patients with cervical myofascial pain and headache, divided into 5 groups (of 33 patients each). The age of the patients was between 19 and 50 years, with posture (position) alterations of the cervical spine, but without significant cervical pathology. All patients used a mobile device in their everyday activities (minimum 2 hours daily) for at least 6 months. Functional evaluation was effectuated before, during and after treatment, and one month after the end of the rehabilitation. In all patients we applied a complex physical-therapeutic program (PT), including analytic exercises for paravertebral muscles and soft tissue techniques [massages, post-isometric relaxation (PIR) for the respective upper trapezius and sterno-cleido-mastoideus muscle] and stimulation of patients' active participation in the process of prevention (education in principles of back-school, self-massage, auto-PIR). The patients in the first group effectuated only these procedures. In the second group, we added elements of manual therapy (MT-tractions, mobilizations, manipulations; and auto-mobilizations). In patients of the next groups, a paravertebral application of a preformed modality was added to the PT and the MT: in group 3-Deep Oscillation (DO); in group 4-lasertherapy (LT); in group 5-magnetic field (MF). Statistical evaluation was performed by SPSS programme, version 17; using t-test (analysis of variances ANOVA) and Wilcoxon rank test (non-parametrical correlation analysis). Results and Analysis: All patients reported a significant decrease of the intensity of cervical pain and headache (evaluated by Visual analogue scale of pain and by pressure dolorimetry). In all patients we observed amelioration of the static position of the cervical spine, reduced amount of paravertebral muscle spasm and of the sensibility of trigger and tender points; and augmentation of range of active motion of the cervical region of the spine. During the rehabilitation period the results were most important in the second group (with manual therapy), but one month later there is not statistical differences between both groups. Discussion and Conclusion: Techniques of PT and MT are very useful for the prevention and the rehabilitation processus of cervical myofascial pain and headache. The program of care includes active (analytic) exercises, PIR and stretching techniques, tractions and mobilizations, education of the patient, and (in some cases) manipulations. The inclusion of preformed modalities (DO, LT, MF) in the complex prevention and rehabilitation program accelerates the effects on pain and spine mobility 81 and ameliorate the stabilization of the results. We consider that every medical doctor-specialist in Physical and rehabilitation medicine, every physiotherapist and ergotherapist must adapt the general algorithm for the needs of the concrete patient.
... The results were maintained for up to six months after treatment and confirm the results of other previous similar studies. Marcus et al. [19] reported that drug-free migraine treatment with relaxation training and thermal biofeedback could be essential for the non-medical treatment of choice for migraine since a large percentage (41.3%) of the individuals in the study reported a significant reduction in headaches. ...
Article
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Biofeedback treatment is among the methods proposed to prevent and treat many organic and mental problems. Many experts carry out biofeedback application since it is applied by psychiatrists, psychologists, doctors, social workers, nurses, and physiotherapists. Biofeedback is a non-invasive, natural method that does not require drugs, although it can be used along with medicines. It is based on the learning and training of individuals on their body's normal functions such as muscle pain, brain waves, heart rate, pain perception, skin conductivity, and blood pressure. It is often used to treat stress, anxiety, headaches, insomnia, tension, urinary incontinence, muscle aches, and other problems. It can be applied in conjunction with other therapies when necessary, such as psychotherapy, meditation, or other alternative therapies. It has many applications with no side effects, does not create dependencies, and can be interrupted at any time.
... Occlusal adjustment is one oftheanother techniquewhich includes dental procedures used to improve a patient's bite, thereby relieving muscle tension in the jaw that might induce or exacerbate migraine pain. Finally, hyperbaric oxygen therapy requires that the patient be placed in a hyperbaric chamber to increase pressurization of the blood gases [12][13][14][15][16][17][18][19][20] . ...
... The study concluded that physiotherapy, when applied as an additional treatment could be useful when other techniques failed. The lack of a control group in this study renders it insufficient (38). ...
Article
Chronic migraine (CM) is a common disorder that compromises the quality of life of patients, decreases functionality, is frequently misdiagnosed, and has poor response to treatment even when diagnosed. Rare and randomized controlled studies on chronic migraine have revealed limitations within current therapeutic options. While pharmacologic treatment includes acute and preventive treatment options, it may lead to some adverse effects, which challenge the tolerance of patients. An increased number of studies in recent years have shown that behavioral interventions such as cognitive behavioral therapy (CBT), biofeedback (BFD), relaxation techniques and neurostimulation procedures lead to a significant improvement in the treatment of chronic migraine. For this reason, such treatment options are recommended, especially in persistent cases with poor response to treatment. The treatment of chronic migraine is more challenging compared with episodic migraine (EM), and recent studies suggest that non-pharmacologic approaches and neurostimulation techniques will increase the chance of success in the treatment of chronic migraine.
... Several studies demonstrated that high stable estrogen levels in pregnancy improve migraine symptoms, with up to 11% of women reporting improvement in the first trimester, 53% in the second and 79% in the third trimester (22,24). Nonpharmacological measures for headache treatment are ice packs, massage, and relaxation as well as avoiding triggers and psychological stress, increasing the amount of sleep (25). Pharmacological treatment considers abortive therapy (paracetamol, opioids, antiemetics, aspirin and other NSAID, caffeine, ergot and triptans) and prophylactic (beta blockers, low dose of aspirin, antidepressants, antiepileptics and other drugs). ...
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Objectives To determine the usefulness of manual treatment in reducing or eliminating pregnancy symptoms during first and second trimester. Methods Manual treatment of the cervical and thoracic spine was performed in a group of 115 pregnant women who developed pregnancy symptoms during normal pregnancy. A rotational traction of the cervical spine was applied. Patients in whom the treatment was unsuccessful underwent second round of treatment after a pause of a minimum 3 days. Patients for whom the treatment was initially successful but later relapsed also repeated whole procedure. Pregnancy symptoms analyzed in this study were heartburn, nausea, vomiting, dizziness, headache, insomnia, neck pain, hyperosmia and hypersalivating. Results Manual treatment successfully treated pregnancy symptoms in 91 (79.1%) patients, it was partially successful for 22 (19.1%), and unsuccessful for 2 patients (1.7%) after the first treatment. After the second treatment, out of a total 56 patients, the treatment was completely successful in 40 (71.4%), partially successful in 14 (25%), and unsuccessful in 2 (3.6%) patients. The highest success rate was in eliminating headache (97.3%), vomiting (95.9%), dizziness (94.5%), nausea (92.9%), neck pain (92.9%), insomnia (91.9%), heartburn (88.8%), hyperosmia (78.5%) and hyper salivating (78%). Conclusion Manual therapy in pregnancy is a drugless, etiological, usually highly effective therapy. It is a low cost, rapid, safe, and well tolerated treatment for pregnancy symptoms which frequently has an immediate effect, thus making it an optimal treatment for pregnancy symptoms.
... The influence of techniques ameliorating the static and dynamic dysfunctions of the high levels of the cervical region proves the dominant role of the upper cervical spine in the generation of this type of back pain and headache [5][6][7]. We consider that the impact of the upper cervical region is determinant not only for the generation of the so called cervicogenic headache, but too -for the initiation and the aggravation of tension-type headache. ...
Article
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Introduction: Ultimately, the introduction of portable devices in the everyday life imposed the necessity to evaluate the possible consequences (of the abuse) on the position of the spine and correspondent structures of the nervous system. Medical specialists are responsible for the construction of programs for prevention of these consequences. The goal of the current article is to evaluate the impact of physical therapy and manual therapy in the treatment and the prevention of cervical myofascial pain and headache, due to spinal malposition in users (abusers) of smart phones. Materials and methods: We observed a total of 69 patients with cervical myofascial pain and headache. The age of the patients was between 19 and 49 years, with posture (position) alterations of the cervical spine, but without significant cervical pathology. All patients used a mobile device in their everyday activities (minimum 2 h daily) for at least 6 months. Functional evaluation was effectuated before, during and after treatment and one month after the end of the rehabilitation. In all patients we applied a complex physical-therapeutic program, including analytic exercises for paravertebral muscles and soft tissue techniques [massages, post-isometric relaxation (PIR) for the respective upper trapezius and sterno-cleido-mastoideus muscle] and stimulation of patients’ active participation in the process of prevention (education in principles of back-school, self-massage, auto-PIR). The patients in the first group effectuated only these procedures. In the second group we added elements of manual therapy (tractions, mobilizations, manipulations; and auto-mobilizations). Statistical evaluation was performed by SPSS program, version 17; using t-test (analysis of variances ANOVA) and Wilcoxon rank test (non-parametrical correlation analysis). Results and analysis: All patients reported a significant decrease in the intensity of cervical pain and headache (evaluated by Visual analogue scale of pain and by pressure dolorimetry). In all patients we observed amelioration of the static position of the cervical spine, reduced amount of paravertebral muscle spasm and of the sensibility of trigger and tender points; and augmentation of range of active motion of the cervical region of the spine. During the rehabilitation period the results were most important in the second group (with manual therapy), but one month later there is not statistical differences between both groups. Discussion and conclusion: Techniques of physical therapy and manual therapy are very useful for the prevention and the rehabilitation processes of cervical myofascial pain and headache. The program of care includes active (analytic) exercises, PIR and stretching techniques, tractions and mobilizations, education of the patient, and (in some cases) manipulations. We consider that every medical doctor - specialist in Physical and rehabilitation medicine and every physical therapist must adapt the general algorithm to the needs of the concrete patient.
... One of the most common physical therapy interventions for headache management is manual therapy (MT),[19][20][21]which we define here as treatments including 'spinal manipulation (as commonly performed by chiropractors, osteopaths, and physical therapists), joint and spinal mobilization, therapeutic massage, and other manipulative and body-based therapies'[22]. Positive results have been reported in many clinical trials comparing MT to controls[23][24][25][26][27], other physical therapies[28][29][30]and aspects of medical care[31][32][33][34]. More high quality research is needed however to assess the efficacy of MT as a treatment for common recurrent headaches. ...
Article
Background: Despite the expansion of conventional medical treatments for headache, many sufferers of common recurrent headache disorders seek help outside of medical settings. The aim of this paper is to evaluate research studies on the prevalence of patient use of manual therapies for the treatment of headache and the key factors associated with this patient population. Methods: This critical review of the peer-reviewed literature identified 35 papers reporting findings from new empirical research regarding the prevalence, profiles, motivations, communication and self-reported effectiveness of manual therapy use amongst those with headache disorders. Results: While available data was limited and studies had considerable methodological limitations, the use of manual therapy appears to be the most common non-medical treatment utilized for the management of common recurrent headaches. The most common reason for choosing this type of treatment was seeking pain relief. While a high percentage of these patients likely continue with concurrent medical care, around half may not be disclosing the use of this treatment to their medical doctor. Conclusions: There is a need for more rigorous public health and health services research in order to assess the role, safety, utilization and financial costs associated with manual therapy treatment for headache. Primary healthcare providers should be mindful of the use of this highly popular approach to headache management in order to help facilitate safe, effective and coordinated care.
... Positive results have been reported in many clinical trials comparing MT to controls [23][24][25][26][27], other physical therapies [28][29][30] and aspects of medical care [31][32][33][34]. More high quality research is needed however to assess the efficacy of MT as a treatment for common recurrent headaches. ...
Article
Full-text available
Background Despite the expansion of conventional medical treatments for headache, many sufferers of common recurrent headache disorders seek help outside of medical settings. The aim of this paper is to evaluate research studies on the prevalence of patient use of manual therapies for the treatment of headache and the key factors associated with this patient population. Methods This critical review of the peer-reviewed literature identified 35 papers reporting findings from new empirical research regarding the prevalence, profiles, motivations, communication and self-reported effectiveness of manual therapy use amongst those with headache disorders. ResultsWhile available data was limited and studies had considerable methodological limitations, the use of manual therapy appears to be the most common non-medical treatment utilized for the management of common recurrent headaches. The most common reason for choosing this type of treatment was seeking pain relief. While a high percentage of these patients likely continue with concurrent medical care, around half may not be disclosing the use of this treatment to their medical doctor. Conclusions There is a need for more rigorous public health and health services research in order to assess the role, safety, utilization and financial costs associated with manual therapy treatment for headache. Primary healthcare providers should be mindful of the use of this highly popular approach to headache management in order to help facilitate safe, effective and coordinated care.
... Positive results have been reported in many clinical trials comparing MT to controls [23][24][25][26][27], other physical therapies [28][29][30] and aspects of medical care [31][32][33][34]. More high quality research is needed however to assess the efficacy of MT as a treatment for common recurrent headaches. ...
Conference Paper
Full-text available
Background Despite the expansion of medical treatments, many sufferers of common recurrent headache disorders (migraine, tension and cervicogenic) seek help outside of medical settings. The aim of this paper was to evaluate the prevalence and key features associated with patient use of manual therapies (MT) for headache treatment. Methods Critical integrative review of the peer-reviewed literature (English) identifying 35 papers between 2000 – 2015 using key words and phrases to search databases (MEDLINE, AMED, CINAHL, EMBASE and EBSCO). Results The combined prevalence rate of MT use across all professions – chiropractic, physiotherapy, osteopathy, massage - averaged 15.9% for those with migraine and 17.7% for for those with headache within general populations. This population seek MT most often for reasons of seeking pain relief, while concurrent use of medical care averaged 60.0%. Conclusions Physical therapies are the most frequently used non-medical treatment for headache disorders across many countries. These findings suggest the need for more public health and health services research to improve healthcare policy, practitioner education and coordination of healthcare services.
... Pressure, temperature, angular and positional systems can also be used as other modes of biofeedback similar to EMG biofeedback [64][65][66][67]. EMG biofeedback is now widely used in the rehabilitation of upper motor neuron lesions and also found that it helps in improving the spastic muscles by relaxing them [68][69][70]. In CP rehabilitation, EMG biofeedback has not been evaluated with any major controlled studies. ...
Chapter
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Persons with Gross Motor Function Classification System (GMFCS) levels IV and V are considered as severe cerebral palsy (CP) and are non-ambulatory. These persons are at a higher risk of complications such as hip displacement (sub-luxation or dislocation), spinopelvicdeformities,musculoskeletalpain,low bonemineraldensity andlow energy fracture.The recommendedmanagement strategyatpresentforthisgroupiswheelchairaidedmobility,withwhichnoneofthesecomplicationscanbeprevented.Thereisastrong need to evaluate alternative methods of treatment that can allow assisted ambulation in persons with severe CP. The role of Single Event Multilevel Lever Arm Restoration and AntiSpasticity Surgery (SEMLARASS) and protocol-based active rehabilitation on gross motor function and ambulation of non-ambulatory persons with CP at GMFCS levels IV andVisexamined.ActiverehabilitationinvolvesmakingthepersonwithsevereCPactive through most ofthe waking hours andparticipating actively in the rehabilitation.A wellplanned and executed SEMLARASS, followed by intensive, protocol-based, sequenced multidisciplinary active rehabilitation, provides the persons with GMFCS levels IV and V a significant functional improvement in gross motor function and mobility.
... The two RCTs on massage therapy included relatively a few participants; both studies showed that massage was significantly better than the control group to reduce migraine intensity and frequency. The study that investigated the effect of physiotherapy on migraine has a decent number of subjects included, but does not include a control group 44 . The subjects were randomly allocated to two groups, one receiving PT and the other relaxation therapy. ...
... Autoren Hay, Madders 1971 Mitchell, Mitchell 1971 Paulley, Haskell 1975 Blanchard et al. 1978 Silver et al. 1979 Attfield, Peck 1979 Daly et al. 1983 Williamson et al. 1984 Janssen, Neutgens 1986 Lisspers, Öst 1990 Marcus et al. 1998 D'Souza et al. 2008 Varkey et al. 2011Dittrich et al. 2008 Darabaneanu et al. 2011 Varkey et al. 2011 Overath et al. 2014Methodik ...
Article
Zusammenfassung Neben medikamentösen und interventionellen Verfahren bestehen zur Behandlung der Migräne nicht medikamentöse Möglichkeiten, die überwiegend der Verhaltenstherapie entstammen. In der Zusammenschau kann dabei aufgezeigt werden, dass bereits eine ausführliche Beratung des Patienten zu positiven Effekten in der Migränehäufigkeit führen kann. Entspannungsverfahren (insbesondere die Progressive Muskelrelaxation nach Jacobson), Ausdauersport und verschiedene Arten von Biofeedback sind neben der Anwendung kognitiver Verhaltenstherapie in der Behandlung der Migräne effektiv. Die Kombination der Behandlungsverfahren selbst mit einer prophylaktischen medikamentösen Therapie führt zu zusätzlichen positiven Effekten.
... Autoren Hay, Madders 1971Mitchell, Mitchell 1971Paulley, Haskell 1975Blanchard et al. 1978Silver et al. 1979Attfield, Peck 1979Daly et al. 1983Williamson et al. 1984Janssen, Neutgens 1986Lisspers, Öst 1990Marcus et al. 1998D'Souza et al. 2008Varkey et al. 2011 ...
Article
Besides pharmacological and interventional treatment options, non-pharmacological options deriving from behavioural approaches may be helpful in the treatment of migraine. Even consulting a patient is able to reduce the frequency of migraine attacks. Relaxation therapy (in particular progressive muscle relaxation), endurance sports, and biofeedback of different modalities as well as cognitive behavioural therapy are effective in the prophylactic treatment of migraine. The combination of these treatment options with prophylactic pharmacological treatment increases these positive effects.
... As most women with migraine improve after the fi rst trimester, they could usually be managed with reassurance and nonpharmacological methods such as ice packs, massage, relaxation and biofeedback. [20] Avoidance of triggers, lack of sleep, and psychological stress together with the habits of regular exercise, regular meals and regular sleep patterns help. [21] Some women, however, continue to have debilitating headache associated with nausea and vomiting and consequent dehydration. ...
Article
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Headache is a very common problem in pregnancy. Evaluation of a complaint of headache requires categorizing it as primary or secondary. Migrainous headaches are known to be influenced by fluctuation of estrogen levels with high levels improving it and low levels deteriorating the symptoms. Tension-type Headaches (TTHs) are the most common and usually less severe types of headache with female to male ratio 3:1. Women known to have primary headache before conception who present with a headache that is different from their usual headache, or women not known to have primary headache before conception who present with new-onset of headache during pregnancy need neurologic assessments for potential secondary cause for their headache. In addition to proper history and physical examination, both non-contrast computed tomography (CT) and Magnetic Resonance Imaging (MRI) are considered safe to be performed in pregnant women when indicated. Treatment of abortive and prophylactic therapy should include non-pharmacologic tools, judicious use of drugs which are safe for mother and fetus.
... Agrupados segundo o sexo, identificou-se diferença significante do nível de tensão muscular e da capaci-RAIMUNDO PEREIRA DA SILVA NETO E COLABORADORES DISCUSSÃO O teste de biofeedback, acoplado ao estudo psicológico do paciente, indica quais os casos que devem aprender técnica de relaxamento muscular para melhor aproveitarem quer o tratamento medicamentoso, quer o psicológico. [5][6][7][8] Os pacientes com nível de tensão alto e capacidade de relaxamento fraca são candidatos indiscutíveis para o aprendizado do relaxamento, 9,10,11 o mesmo ocorrendo com aqueles que apresentam nível de tensão médio e capacidade fraca de relaxamento. Ao final do aprendizado, o paciente é submetido novamente ao teste no aparelho de biofeedback, e sua evolução é anotada para comparação. ...
Article
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Objectives: Evaluate the muscular tension and relaxation capacities of migraine patients. Select a group to train in muscular relaxation techniques to help reduce migraine occurrences. Method: The study consists of 123 migraine patients, diagnosed in accordance to International Headache Society criteria and diagnosed using biofeedback. Results: Among those chosen for the study, 26 (21.1%) were males and 97 (78.9%) female. The average age was 35 ± 13 years and 38 ± 11 years for males and females, respectively. Sixty (48.8%) patients presented high levels of muscular tension and 63 (51.2%) were diagnosed to have low relaxation capacities. The association between high muscular tension and low relaxation capacity was found predominantly in females. Of the 123 subjects analyzed, 71 (57.7%) were prescribed training in relaxation techniques. Conclusions: The women studied presented a high level of muscular tension associated with low relaxation capacity with greater frequency. The majority were subsequently referred to treatment using relaxation techniques.
... In einer Vielzahl von Studien konnte die Überlegenheit multimodaler Therapieansätze in der Schmerzmedizin im Vergleich zu einem unimodalen Vorgehen nachgewiesen werden. Insbesondere für den Rückenschmerz, inklusive des Halswirbelsäulensyndroms, ist die Evidenzlage inzwischen unumstritten [2,3,4,8,13,15,30,31], aber auch für chronische Kopfschmerzen [7,19,29] und multilokuläre Schmerzerkrankungen [12,22,28] konnte in guten kontrollierten Studien die Effektivität eines interdisziplinären multimodalen Vorgehens belegt werden. ...
Article
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Multimodale Therapieansätze haben sich in der Schmerzbehandlung als erfolgreich erwiesen. Eine flächendeckende Versorgung mit multimodaler Schmerzbehandlung ist in Deutschland derzeit aber nicht gegeben. Zur Feststellung des Istzustands hinsichtlich definierter Kriterien der Struktur- und Prozessqualität der multimodalen Schmerztherapie wurde eine Befragung von 37 schmerztherapeutischen Einrichtungen in Deutschland durchgeführt, die Datenerhebung erfolgte mittels anonymisierter Fragebogen. Die Fragen beantworteten 23 Einrichtungen. Bezüglich der vorhanden Räume und des eingesetzten Personals ist zwischen den Einrichtungen eine relativ große Übereinstimmung zu verzeichnen. Interdisziplinäre Assessments führen alle Einrichtungen durch, allerdings mit sehr variablem zeitlichem Aufwand. Der theoretische Fokus der Behandlung basiert in allen Einrichtungen auf einer „gemeinsamen Philosophie“ aller beteiligten Berufsgruppen, die im Sinne eines verhaltensmedizinisch orientierten Programms das Ziel hat, Schonhaltung und Hilflosigkeit abzubauen sowie körperliche und psychosoziale Aktivität und Selbsteffizienz zu steigern. In den Therapieprogrammen zeigen sich hinsichtlich der Mittel und Wege zur Erreichung dieser Ziele auch Unterschiede.
... Over time, fewer and fewer muscle groups are tensed and released and, eventually, the person can relax the body at will without tensing beforehand. A combination of PMR, diaphragmatic breathing training, and biofeedback is often used in behavioral interventions for chronic pain in adults and children [17,[20][21][22][23]. ...
Article
Study design: We conducted a structured review of eight mind-body interventions for older adults with chronic nonmalignant pain. Objectives: To evaluate the feasibility, safety, and evidence for pain reduction in older adults with chronic nonmalignant pain in the following mind-body therapies: biofeedback, progressive muscle relaxation, meditation, guided imagery, hypnosis, tai chi, qi gong, and yoga. Methods: Relevant studies in the MEDLINE, PsycINFO, AMED, and CINAHL databases were located. A manual search of references from retrieved articles was also conducted. Of 381 articles retrieved through search strategies, 20 trials that included older adults with chronic pain were reviewed. Results: Fourteen articles included participants aged 50 years and above, while only two of these focused specifically on persons aged >or=65 years. An additional six articles included persons aged >or=50 years. Fourteen articles were controlled trials. There is some support for the efficacy of progressive muscle relaxation plus guided imagery for osteoarthritis pain. There is limited support for meditation and tai chi for improving function or coping in older adults with low back pain or osteoarthritis. In an uncontrolled biofeedback trial that stratified by age group, both older and younger adults had significant reductions in pain following the intervention. Several studies included older adults, but did not analyze benefits by age. Tai chi, yoga, hypnosis, and progressive muscle relaxation were significantly associated with pain reduction in these studies. Conclusion: The eight mind-body interventions reviewed are feasible in an older population. They are likely safe, but many of the therapies included modifications tailored for older adults. There is not yet sufficient evidence to conclude that these eight mind-body interventions reduce chronic nonmalignant pain in older adults. Further research should focus on larger, clinical trials of mind-body interventions to answer this question.
... The major concern in the management of the pregnant patient with migraines, as with other medical disorders, is the effect of both the medication and the disease on the fetus. As most women with migraines improve after the first trimester, they can usually be managed with reassurance and nonpharmacological measures such as ice packs, massage, relaxation, and biofeedback [33,34]. A holistic approach yields the best results with avoidance of triggers, lack of sleep, and psychological stress. ...
Article
Full-text available
Headache is a very commonly encountered symptom in pregnancy and is usually due to primary headache disorders which are benign in nature. It can however be quite debilitating for some women who may need therapeutic treatment of which there are several options safe to use in pregnancy. It is equally important though to recognise that headache may be a sign of serious underlying pathology. This paper aims to provide a clinically useful guidance for differentiation between primary and secondary headaches in pregnancy. The primary headache disorders and their management in pregnancy are explored in depth with brief overviews of the causes for secondary headaches and their further investigation and management.
... 41 Furthermore, a combination of physical therapy and biofeedback has been shown to provide greater relief than physical therapy alone. 42 Outcome Patients with chronic migraine may revert back to episodic migraine. Reversion rates at one year range from 56 to 70% in population-based and specialty headache clinic-based samples, respectively. ...
Article
Chronic daily headache (CDH) is a descriptive term that encompasses multiple headache diagnoses and affects approximately 4% of the general adult population. Chronic daily headache results in significant pain and suffering with substantial impact on quality of life, and enormous economic costs to society. Although most patients with primary CDH suffer from chronic migraine or chronic tension-type headache, other primary and secondary headache disorders can also manifest as a CDH syndrome. For CDH management to succeed, secondary headaches need to be ruled out with proper investigations when judged necessary. If the diagnosis of primary CDH is established, diagnosis of the specific CDH subtype is imperative to institute appropriate treatment. The diagnosis and management of distinct CDH entities, chronic migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua, are the primary forms of CDH and the emphasis of this review. Although, strictly speaking, medication overuse headache is a secondary form of CDH, it is also highlighted in this review given its frequent association with primary CDH.
Thesis
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Objective To assess the efficacy of physiotherapy on headache intensity, duration, frequency, and quality of life of patients with migraine and to present the different physiotherapeutic modalities. Methods Systematic search strategy by predefined eligibility criteria was conducted in the databases Web of Science, Medline via PubMed, Physiotherapy Evidence Database (PEDro), the Cochrane library and PhysioLink. Additional handsearch of reference lists has been performed and the cut-off date for all searches was the 20th of April 2020. Risk of bias assessment of the selected studies was performed using the revised Cochrane risk of bias tool for randomized trials (RoB2). Results Ten studies have been identified in study selection process. One had high risk of bias, eight did at least have some concerns and one had low risk of bias in the RoB2 assessment. Interventions used were multimodal physiotherapy (PT) protocol, different manipulative/mobilization techniques, trigger point (TrP) therapy, lymphatic drainage (LD), traditional massage (TM) and stretching techniques. Most frequent outcome (9/10) was headache frequency (9/10), followed by intensity (8/10), Quality of Life (QoL; 6/10) and duration (3/10). All interventions had significant effects on outcome parameters compared to baseline (BL). Discussion Meta-analysis and statements on superiority of intervention modalities were not possible, due to high heterogeneity of collected data. Further research on physical etiology and impact on individual physiotherapeutic modalities must be pursued to establish evidence-based treatment strategies. Conclusion Physiotherapeutic modalities included in this review seemed to be beneficial for investigated outcomes for migraineurs. Physiotherapeutic treatment could enhance effects of medical treatment and may result in lowering economic burden of migraine.
Article
Neben medikamentösen und interventionellen Verfahren bestehen zur Behandlung der Migräne nichtmedikamentöse Möglichkeiten, die großenteils der Verhaltenstherapie entstammen. In der Zusammenschau kann dabei aufgezeigt werden, das bereits eine ausführliche Beratung des Patienten zu positiven Effekten in der Migränehäufigkeit führen kann. Entspannung (insbesondere die progressive Muskelrelaxation nach Jacobson), Ausdauersport und verschiedene Arten von Biofeedback sind neben der Anwendung kognitiver Verhaltenstherapie in der Behandlung der Migräne effektiv. Die Kombination der Behandlungsverfahren selbst und mit medikamentöser Therapie führt zu zusätzlichen positiven Effekten.
Chapter
Non-drug headache treatments that can be safely used during pregnancy and lactation include pain management techniques, exercise, smoking cessation, and lifestyle regulation. Non-pharmacological approaches can be helpful during preconception, pregnancy, and lactation. Relaxation and stress management are the most effective non-drug treatments. Dietary recommendations during pregnancy and lactation include not skipping meals, consuming regular, nutritious, balanced meals and snacks, maintaining adequate hydration, and using prenatal vitamins. Elimination diets are usually not helpful and should not be recommended during pregnancy. Other useful modalities include aerobic exercise, physical therapy, and massage.
Chapter
Neben der Möglichkeit der medikamentösen Therapien gibt es auch eine Vielzahl von nichtmedikamentösen Methoden, die sowohl in Kombination mit konventionellen Pharmaka, aber auch als alleinige Maßnahmen gegen das Symptom „Kopfschmerz“ eingesetzt werden können. Wenngleich es nur für wenige dieser nichtmedikamentösen Verfahren einen nachgewiesenen Therapieerfolg durch wissenschaftlich fundierte und anerkannte Studien gibt, zeigt die klinische Erfahrung gute Therapieerfolge im Einsatz mit nichtmedikamentösen Methoden.
Chapter
The treatment-resistant medication overuse headache (MOH), chronic migraine (CM), new daily persistent headache (NDPH), and chronic tension-type headache (CTTH) patients often need an intensive interdisciplinary program. Physical therapy, medical, and focused psychological therapy are combined to create a treatment plan for each patient over a period of several weeks. Utilizing the same abortive and preventive principles found to be successful for less resistant cases, the treatment plan adds paced physical rehabilitation and individually tailored stress reduction, psychotherapy, and biofeedback. It is necessary to include behavioral evaluation and treatment, because ignoring psychological ramifications of chronic pain states, including headaches, as well as the psychological comorbidity commonly seen in the patient population, is tantamount to ignoring intra-abdominal trauma as the cause of shock in the severe accident-related head trauma case! This chapter explores the medical treatment of chronic daily headache and suggests that successful treatment of refractory chronic headache patients is possible with an interdisciplinary approach.
Book
More than 28 million Americans suffer from migraine headaches, with migraine affecting nearly one in five women in their reproductive years. Effective Migraine Treatment in Pregnant and Lactating Women: A Practical Guide, provides a comprehensive resource to address diagnosis, testing, and treatment of headaches in reproductively fertile women. This important new book offers a wealth of practical, ready-to-use, clinically tested tips and recommendations to treat women with headaches during pregnancy and nursing. Although women may ideally prefer to restrict migraine treatments during pregnancy, up to one in three pregnant women self-medicate for symptoms, especially with analgesics. Fortunately, there are many effective treatment options that can be safely used when pregnant and breastfeeding. Available therapies include medication and nonmedication treatments, traditional and alternative therapies, and nutritional supplements. This book uniquely answers frequently asked questions by patients and offers healthcare providers easy-to-use office tools for patient education and charting documentation. The authors of this important new work have collaborated to provide a resource that will help clinicians provide women with the tools and knowledge to become empowered and to gain control over their migraines when trying to conceive, during pregnancy, and when nursing. © Humana Press, a part of Springer Science-Business Media, LLC 2009.
Article
Background: Migraine is one of the most frequent headaches. Cervical myofascial and trigger point disorders are effective factors on accession of this type of headache. PRT is an indirect technique that treats trigger points. Objective: The purpose of this study was to compare the effectiveness of trigger points' management by positional release therapy (PRT) combined with routine medical therapy and routine medical therapy alone in treatment of migraine headache. Methods: Forty-four patients with active trigger points in cervical muscles entered to the study. They were randomly assigned to PRT-medical therapy or medical therapy group. Headache frequency, intensity, duration and tablet count were recorded by use of a daily headache diary. The sensitivity of trigger points was assessed by the use of a digital force gauge (Wagner-FDIX). Cervical range of motion was measured by a goniometer. Results: Both groups showed significant reduction in headache intensity, frequency, duration and tablet count after 4 months follow up. The sensitivity of trigger points and all cervical range of motions significantly increased in PRT-medical group after 4 months follow up; however in medication group except cervical right lateral flexion, right and left rotation the other factors showed no change after 4 months follow up. In comparison of the two study groups, there was no significant difference in headache-related variables. Apart from the headache intensity and tablet count, the trends of other factors were significantly different between the two groups (p < 0.05). Conclusions: The combined PRT-medical therapy is more effective than the medical therapy alone. Thus, the combination of PRT and medical therapy is suggested as a treatment choice for patients with migraine headache.
Article
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Professional psychology is in apparent conflict about its relationship to “complementary” and “alternative” medicine (CAM)—some scholars envision a harmonious partnership, whereas others perceive irreconcilable differences. We propose that the field’s ambivalence stems at least partly from the fact that inquiring psychologists can readily point to peer-reviewed empirical evidence (e.g., published reports of randomized controlled trials) to either substantiate or refute claims for the efficacy of most CAM modalities. Thankfully, recent intellectual developments in the fields of medicine and scientific psychology—developments which we refer to collectively as the science-based perspective—have led to the identification of several principles that may be used to judge the relative validity of conflicting health intervention research findings, including the need to consider (a) the prior scientific plausibility of a treatment’s putative mechanism-of-action; and, commensurately, (b) the degree of equivalence between treatment and control groups—except for the single active element of the treatment believed to cause a specific change, all else between the two groups should be identical. To illustrate the potential of this approach to resolve psychology’s CAM controversy, we conducted a re-review of the research cited by Barnett and Shale [2012; Professional Psychology: Research and Practice, 43(6), 576-585] regarding the efficacy of 11 types of CAM that psychologists might endorse. Less than 15% of the studies we reviewed (N = 239) employed research designs capable of ruling out non-specific effects, and those that did tended to produce negative results. From a science-based perspective, psychologists should reject CAM in principle and practice.
Article
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Huvudvärk är ett av de vanligaste hälsoproblemen i befolkningen i allmänhet med en punktprevalens på drygt 16% (1). I en undersökning av korttidsfrånvaron inom norsk industri utgjorde huvudvärk 6,2%av frånvaron, vilket medför betydande samhällsekonomiska kostnader (2). Livskvalitetsstudier visar också att patienter med migrän hindras lika mycketav sina besvär som patienter med angina pectoris och diabetes mellitus (3).Epidemiologiska studier kan användas för att belysa olika problemställningar: problemets storlek, vilka som drabbas, svårighetsgrad och grad av funktionsnedsättning, diagnostik och behandling, riskfaktorer, komorbiditet och effekt av interventioner. Prevalens Flera epidemiologiska studier visar varierande prevalens för migrän från cirka 3-4% till 35% (4). Det finns flera skäl till variationerna i de publicerade resultaten. Urvalet av den undersökta populationen anses vara av betydelse. Det är få personer som söker läkare för sin huvudvärk. Av ett randomiserat urval av den allmänna befolkningen hade bara 56% av de individer som hade migrän kontaktat sin allmänläkare för besvären och bara 16% hade sökt specialistläkare (5), vilket också har bekräftats i andra studier (6). Epidemiologiska studier grundade på kliniska populationer är därför inte representativa för befolkningen i stort (7). Det är viktigt att epidemiologiska studier genomförs med en representativ population också för att man ska kunna studera sambanden mellan migrän och andra sjukdomstillstånd. Man kan få ett falskt intryck av att det föreligger ett samband mellan två sjukdomstillstånd om man undersöker kliniska populationer, eftersom personer som uppsöker sjukvården oftare har två typer av besvär än de som inte vänder sig till sjukvården (8). Därför är ett representativt urval av befolkningen att föredra och det har visats att det inte är någon säker skillnad i migränprevalens mellan stad och landsbygd (9-11). Stewart et al. genomförde en metaanalys av totalt 58 publicerade prevalensstudier på migrän, varav 24 inkluderades i analysen (12). Trots att det förelåg en stor variation i prevalens mellan de olika studierna fann man att 70% kunde förklaras utifrån olikheter i kön, ålder och definitionen av migrän. För 30% av variationen fann man ingen säker förklaring utifrån de uppgifter som förelåg. Man kunde utifrån upplysningarna i studierna inte utesluta betydelsen av skillnader i sociodemografiska förhållanden.
Book
This is the first new book in many years to provide a comprehensive review of the latest theory, research, and treatment of chronic headaches from a biopsychological perspective. It is designed to make the tools of assessment and therapy widely accessible, while placing them in the context of how the disorders arise. The physiology and psychology of pain, and each disorder, are reviewed in an accessible manner. Clinical experience, laboratory data, and illustrative vignettes aid in treatment selection. Part I introduces the major types of headaches and provides a comprehensive review of pain. Part II details the major forms of headaches—migraine, tension-type, cluster, secondary, and headaches in children. A clinical presentation introduces each type of headache, followed by the physiological and psychological underpinnings and their implications for assessing and treating patients. Part III serves as a clinical guide for practitioners. The book closes with an analysis of how well the treatments work, the mechanisms behind the efficacy, and guidelines for treatment matching. A range of practical tools is incorporated. Clinical evaluation is reviewed in depth, including the interview, psychometrics, and psychophysiological assessment. Key sections of the 2004 International Headache Society diagnostic criteria serve as a “mini” diagnostic manual. Tables allow rapid look-up of the various disorders and their distinguishing characteristics; trigger point referral patterns; and the comparative merits of migraine medications. Blank headache diaries, appropriate for various stages of treatment, serve as models. A relaxation exercise is provided, as are muscle tension and hand temperature norms. Key terms are defined in the extensive glossary to help psychologists and medical professionals share vocabulary. Medical, herbal, and behavioral therapies are discussed in terms of the underlying science. Chronic Headaches is intended for healthcare providers, pain specialists, psychologists, researchers, and clinicians who study headaches in a variety of disciplines. This accessible, student-tested text is ideal for graduate courses on the psychology of pain and/or chronic headaches. Readers will gain expertise in headaches and a clear sense of how to translate this knowledge into clinical practice. CONTENTS Foreword Preface Part I: Foundations Headache Nosology and Warning Signs Pain Neurophysiology and Perception Psychological Variables in Chronic Pain Part II: Principal Types of Headaches: Physiology and Psychology Migraines Psychophysiology of Migraine Tension-Type Headaches Other Primary Headaches: Chronic Daily and Cluster Headaches Benign Secondary Headaches: Cervicogenic, Temporomandibular Dysfunction, Trigeminal Neuralgia, and Posttraumatic Headache Headaches in Children Part III: Clinical Guide to Headaches Headache Triggers A Guide to Headache Medications Clinical Assessment in Behavioral Medicine Elements of Behavioral Medicine Treatment Part IV: Behavioral Medicine Treatment Outcome Literature Outcome: Meta-Analyses and Representative Studies Process: Studies of the Components of Behavioral Treatment Patient Selection and Treatment Matching Long-Term Outcome and Future Directions
Article
ABSTRACT Objective: To evaluate the likelihood of reproducing a migraine patient's typical head pain with pressure on muscles and ligaments [the myofascial examination] and to evaluate the success of a home program of physical therapist supervised stretching of involved muscles along their lengths [PTS] in reducing the headache of migraine. Methods: A pilot prospective observational study. Forty-nine consecutive migraine patients were classified and grouped by International Classification of Headache Disorders-II criteria. All patients with headaches reproduced by the myofascial exam were prescribed PTS. Patients estimated their global improvement by percentage. Improvement of the ICHD-II groups completing treatment was compared to that of groups declining treatment. Results: The headaches of all patients having migraine without aura and chronic migraine and of five of 11 having migraine with aura were reproduced by the myofascial exam. For all migraineurs whose headaches could be reproduced by the myofascial exam the mean improvement of those having PTS was 68 percent. In the group that did not have PTS, mean improvement was 5 percent. In the group that had PTS, 88 percent had 50 percent or greater improvement. In the group that was offered PTS but did not have it, this rate was 10 percent Conclusions: The myofascial examination of the head and neck reproduced the headache pain of most patients having migraine. The PTS is effective in treating these headaches. The myofascial examination should be used to determine treatment for migraineurs.
Article
Full-text available
Multimodal therapy has demonstrated good clinical effectiveness in the treatment of chronic pain syndromes. However, within the German health system a comprehensive and nationwide access to multimodal therapy is not available and further improvement is therefore necessary. In order to analyze the current status of multimodal therapy and specifically its structural and procedural requirements and qualities, a survey was carried out in 37 pain clinics with established multimodal treatment programs. An anonymous questionnaire was used for data collection. Results demonstrated that a substantial accordance was found between all pain clinics concerning requirements for space, facilities and staff. Structured multidisciplinary assessments were carried out by all pain clinics even though the amount of time allocated for this varied widely. The main focus of multimodal therapy in all facilities was based on a common philosophy with a cognitive-behavioral approach to reduce patient helplessness and avoidance behavior and to increase physical and psychosocial activities as well as to strengthen self-efficacy. Some differences in the ways and means to achieve these goals could be demonstrated in the various programs.
Article
Objective.—To test the effectiveness of a multidisciplinary management program for migraine treatment in a group, low cost, nonclinical setting. Design.—A prospective, randomized, clinical trial. Background.—Although numerous studies document the efficacy of pharmacological migraine management, it is unclear whether an effective long-term management approach exists. Methods.—Eighty men and women were randomly assigned to 1 of 2 groups. The intervention group consisted of a neurologist and physical therapist intake and discharge, 18 group-supervised exercise therapy sessions, 2 group stress management and relaxation therapy lectures, 1 group dietary lecture, and 2 massage therapy sessions. The control group consisted of standard care with the patient's family physician. Outcome measures included self-perceived pain intensity, frequency, and duration; functional status; quality of life; health status; depression; prescription and nonprescription medication use; and work status. Outcomes were measured at the end of the 6-week intervention and at a 3-month follow-up. Results.—Forty-one of 44 patients from the intervention group and all 36 patients from the control group completed the study. There were no statistically significant differences between the 2 groups before intervention. Intention to treat analysis revealed that the intervention group experienced statistically significant changes in self-perceived pain frequency (P = .000), pain intensity (P = .001), pain duration (P = .000), functional status (P = .000), quality of life (P = .000), health status (P = .000), pain related disability (P = .000), and depression (P = .000); these differences retained their significance at the 3-month follow-up. There were no statistically significant changes in medication use or work status. Conclusions.—Positive health related outcomes in migraine can be obtained with a low cost, group, multidisciplinary intervention in a community based nonclinical setting.
Article
Headache is a frequent symptom in women of childbearing age and during pregnancy. Benign and pathologic headaches may change in response to changes in estrogen after conception. Expected patterns of change are described for headaches that occur commonly during pregnancy. In addition, although treatment options are limited during pregnancy, a variety of effective medication and nonmedication treatments are available and should be offered to women with benign headaches that persist into the second trimester of pregnancy.
Article
Full-text available
The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105-190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version.
Article
Full-text available
Migraine is one of the most prevalent neurological disorders in Europe, severely affecting ability to work and quality of life. Medical therapies are considered to be the "gold standard" of treatment. This study addresses osteopathic treatment for acute therapy or prophylactic therapy as an alternative to traditional therapies. Forty-two (42) female patients with migraine were randomized into an intervention group (n = 21) and a control group (n = 21). Outcomes were evaluated with three questionnaires before the treatment (t1) and 6 months later (t2). The intervention group received five 50-minute osteopathic manipulative treatments (OMT) over a 10-week period. The control group did not receive OMT, sham treatment, or physical therapy. Patients of this group only filled the questionnaires. Both groups continued with previously prescribed medication. The Migraine Disability Assessment (MIDAS) and Short Form-36 (SF-36) questionnaires as well as a German "pain questionnaire" were used to assess pain intensity, the impact of migraine on daily life and health-related quality of life (HRQoL), and the number of days subjects suffered from migraine. Three (3) of the eight HRQoL domains of the SF-36 form in the intervention group showed significant improvement (from t1 to t2), with a general betterment exhibited in the other domains. The total MIDAS score, pain intensity, and disturbance in occupation due to migraine as well as number of days of disablements were also significantly reduced. The control group showed insignificant differences in these areas. This study affirms the effects of OMT on migraine headache in regard to decreased pain intensity and the reduction of number of days with migraine as well as working disability, and partly on improvement of HRQoL. Future studies with a larger sample size should reproduce the results with a control group receiving placebo treatment in a long-term follow-up.
Article
Full-text available
El dolor crónico de la migraña es uno de los síndromes más comunes, caracterizado por dolores de cabeza recurrentes, el cual afecta al 25% de la población. El dolor es un fenómeno perceptivo que necesita un enfoque multidimencional. En la migraña, además de tener una explicación neurológica, se han encontrado correlaciones con la calidad de vida, el trabajo, el estrés o componentes de tipo psicosocial. Se han empleado en las últimas décadas tratamientos cognitivo-conductuales combinados con técnicas de relajación y retroalimentación, los cuáles han aportado resultados que aunque no del todo contundentes, son una alternativa importante para los pacientes con migraña. En este artículo se analizan las características del dolor crónico y los factores psicológicos asociados, para después hacer una revisión sobre el dolor crónico de la migraña y la efectividad del tratamiento cognitivo conductual.
Article
Thesis (M.S.)--University of Southern California, 2002. Includes bibliographical references (leaves 22-24).
Article
Full-text available
A proportion of headache patients should be evaluated by a neurologist. These guidelines are developed to help physicians in making appropriate choice in the work-up and treatment of headache patients. Most migraine sufferers have not been diagnosed by a physician and are not receiving medical guidance to effectively address their migraine attacks. In the past 15 years new therapies (acute and preventive) have been introduced. In migraine patients nonresponders to analgesics, especially in patients with moderate to severe migraine, triptans should be introduced. In migraine with frequent attacks or long lasting attacks, preventive treatment according to comorbid diseases should be recommended. In tension type headache, an underlying pathology should be excluded; management includes pharmacological and non-pharmacological treatment. Although rare, patients with cluster headache experience major pain and disability; in acute management oxygen inhalation or triptans are recommended, in certain cases prophylaxis is indicated. These guidelines contain classification, diagnostic criteria, and principles of management of all primary headaches. These recommendations for headache treatment are based on a comprehensive review and meta-analysis of scientific literature with regard to treatment possibilities in Croatia.
Article
Full-text available
The complexity of chronic pain has represented a major dilemma for clinical researchers interested in the reliable and valid assessment of the problem and the evaluation of treatment approaches. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI) was developed in order to fill a widely recognized void in the assessment of clinical pain. Assets of the inventory are its brevity and clarity, its foundation in contemporary psychological theory, its multidimensional focus, and its strong psychometric properties. Three parts of the inventory, comprised of 12 scales, examine the impact of pain on the patients' lives, the responses of others to the patients' communications of pain, and the extent to which patients participate in common daily activities. The instrument is recommended for use in conjunction with behavioral and psychophysiological assessment strategies in the evaluation of chronic pain patients in clinical settings. The utility of the WHYMPI in empirical investigations of chronic pain is also discussed.
Article
Full-text available
This experiment tested a cognitive-behavioral rheumatoid arthritis treatment designed to confer skills in managing stress, pain, and other symptoms of the disease. We hypothesized that a mediator of the magnitude of treatment effects might be enhancement of perceived self-efficacy to manage the disease. It was predicted that the treatment would reduce arthritis symptoms and possibly would improve both immunologic competence and psychological functioning. The treatment provided instruction in self-relaxation, cognitive pain management, and goal setting. A control group received a widely available arthritis helpbook containing useful information about arthritis self-management. We obtained suggestive evidence of an enhancement of perceived self-efficacy, reduced pain and joint inflammation, and improved psychosocial functioning in the treated group. No change was demonstrated in numbers or function of T-cell subsets. The magnitude of the improvements was correlated with degree of self-efficacy enhancement. Key words: cognitive-behavioral treatment, perceived self-efficacy, pain reduction, joint inflammation, rheumatoid arthritis (RA)
Article
The purpose of the present study was to examine factors that influence individual differences in treatment response after multidisciplinary pain management. Pre-post assessment design. 119 chronic pain inpatients. Outcome measures included pain report from the McGill Pain Questionnaire, emotional distress from the Symptom Checklist-90 Revised, and activity discomfort from the Activity Discomfort Scale. Process measures included the Family Environment Scale, the Coping Strategies Questionnaire, and the Inventory of Negative Thoughts in Response to Pain. Results indicated that pretreatment family environment, cognitive coping strategies, and negative thinking accounted for small yet significant proportions of the variance in outcome. The proportion of variance accounted for by the changes in cognitive coping and negative thinking was somewhat higher. An increase in pain control and rational thinking was related to decreases in depression and anxiety, pain report, and activity discomfort. Decreases in negative social cognitions were related to decreased depression at posttreatment. Changes in coping strategies and negative thinking may be important mechanisms related to improvement, or lack of improvement, in a range of outcome measures. Patients from families who are controlling and disorganized, and patients high on negative thinking at pretreatment may represent high-risk groups in need of further individually tailored interventions.
Article
Ten reports of prospective follow-ups of at least 12 months duration for behavioral treatment of chronic headache are summarized and reviewed. The available data support two tentative conclusions for tension headache: headache relief from cognitive therapy or relaxation training (possibly followed by frontal EMG biofeedback) is maintained for 2 and 4 years, respectively, while the initial headache reduction obtained with frontal EMG biofeedback alone deteriorates progressively (but not back to pretreatment level_ at 2 and 3 years. For migraine headache, there is good maintenance of headache reduction at 12 months. However, for vascular headache (migraine and combined migraine and tension) treated with relaxation and thermal biofeedback, there is tentative support for a persistent, progressive deterioration, year-by-year, to a four-year follow-up point.
Article
The relative efficacy of several psychological treatments for headache were compared to each other and to the effects of medication placebo using a procedure known as meta-analysis. Results showed that, for migraine headache, temperature biofeedback alone, relaxation training alone, or temperature biofeedback combined with autogenic training were equally effective and significantly superior to medication placebo. For tension headache, the results showed that frontal EMG biofeedback alone, or combined with relaxation training, or relaxation training alone were equally effective and significantly superior to medication placebo or psychological placebo. The latter two do not differ but are significantly superior to continued headache monitoring only.
Article
SYNOPSIS Seventy-nine patients with chronic headaches of diverse causes, recruited from a headache clinic's biofeedback facility, were administered the Multidimensional Pain Inventory (MPl) for measuring the cognitive, behavioral, and affective dimensions of pain. Using the statistical technique of cluster analysis to organize the results, three clusters emerged, and were similar in their characteristics to those named “Dysfunctional”, “Interpersonally Distressed”, and “Adaptive Coper” by other authors who had applied the Inventory and the cluster analysis technique to other populations (one population containing heterogenous groups of chronic pain patients, and another population of patients suffering from “temporomandibular joint disorders”.) Additional analyses of our results confirmed that the three groups were distinct from one another; and that age, sex, duration of complaint, and diagnosis, were not factors in the formation of the groups. Our results suggest that the MPI is a valid measure of the cognitive, behavioral and affective aspects of pain. Rather than apply a similar intervention program to all headache patients, it might be more effective to tailor treatment to the variations in these aspects exhibited by patients in the three different clusters.
Article
SYNOPSIS A six-week cardiovascular exercise program was provided to 11 subjects classified as experiencing classical migraines, while 9 similarly-classified subjects served as waiting-list controls. Measures included the Canadian Aerobic Fitness test, a headache diary to record the Frequency, Intensity, and Duration of migraine episodes and the Pain-Severity, Affective-Distress, and Support scales of the West Haven-Yale Multidimensional Pain Inventory (MPI). Measures were taken on both treatment and control subjects before, mid-way through, and upon termination of the first aerobic program, as well as after a two week follow-up. The aerobic classes were effective in significantly improving cardiovascular fitness. Pain Severity decreased significantly for those receiving aerobic training, who also showed (nonsignificant) trends, over the measurement periods, toward reductions in Affective Distress as well as the Frequency, Intensity and Duration of migraines, but these trends failed to reach statistical significance. Control subjects demonstrated no systematic changes in any of the dependent measures. These results suggest possible long-term benefits of aerobic fitness in the management of classical migraines.
Article
The efficacy of progressive relaxation, fingertip temperature training, and EMG training of the frontalis muscles was tested against chronic migraine and tension headaches in a double-blinded 32 design. All 56 subjects reported being conditioned in the course of the nine 1/2-hour training sessions. Detailed records of perceived severity and duration of the headaches were maintained by the subjects before the study and for at least 3 months after the training period. While even a conservativeF revealed a diminution of perceived severity, of hours/month of headache, and of an index conceived by Budzynski, Stoyva, Adler, and Mullaney (1973), across time, at beyond the .05 level of significance, no specific treatment emerged as clearly most effective for either type of headache. Over time, however, progressive relaxation was not as good as the other procedures in reducing the number of hours/month of headache.
Article
SYNOPSIS Previous headache studies have been unable to verify the presumed presence of headache. Attempting to correct this design fault, the present study assessed four psychophysiological measures (frontalis EMG, temporal BVP, temporal and finger skin temperature) and salient subjective measures in 13 migraineurs, eight muscle-contraction headache sufferers, and 13 age-matched normals. All subjects submitted to two 30-minute sessions of quiet monitoring, and for the headache subjects, one of the sessions was headache active. A bogus, but convincing preliminary ”assessmentldquo; revealed insufficient headache activity in the headache active session, forcing subjects to reschedule that session in the future when a strong headache was present. A parallel manipulation was employed with the normal subjects. A MANOVA failed to discriminate within- or between-group differences on the psychophysiological measures. Self-reported pain was uncorrelated with the psychophysiological indices. These results cast further doubt on the validity of the psychophysiological measures employed in this study, the same ones routinely endorsed by headache researchers and therapists. We discuss problems of recruitment, compliance, and attrition in basic headache research.
Article
In order to generate information about the relative effectiveness of the most widely used pharmacological and non-pharmacological interventions for the prophylaxis of recurrent migraine (i.e., propranolol HCl and combined relaxation/thermal biofeedback training), meta-analysis was used to integrate results from 25 clinical trials evaluating the effectiveness of propranolol and 35 clinical trials evaluating the effectiveness of relaxation/biofeedback training (2445 patients, collectively). Meta-analysis revealed substantial, but very similar improvements have been obtained with propranolol and with relaxation/biofeedback training. When daily recordings have been used to assess treatment outcome, both propranolol and relaxation/biofeedback have yielded a 43% reduction in migraine headache activity in the average patient. When improvements have been assessed using other outcome measures (e.g., physician/therapist ratings), improvements observed with each treatment have been about 20% greater. In both cases, improvements observed with propranolol and relaxation/biofeedback have been significantly larger than improvement observed with placebo medication (14% reduction) or in untreated patients (no reduction). Meta-analysis thus revealed substantial empirical support for the effectiveness of both propranolol and relaxation/biofeedback training, but revealed no support for the contention that the two treatments differ in effectiveness. These results suggest that greater attention should be paid to determining the relative costs and benefits of widely used pharmacological and non-pharmacological treatments.
Article
Forty patients with tension headache and 40 healthy comparable control persons were palpated by the same "blinded" observer. Tenderness in 10 pericranial muscles on each side was rated on a four-point scale. A Total Tenderness Score was calculated for each individual by adding the scores from all palpated areas. Headache patients had significantly higher scores than controls and also significantly higher tenderness in each point separately. Median normal values and confidence limits for tenderness are given. Among 23 patients with daily headache a correlation was found between headache intensity and Total Tenderness Score. It is likely that the pathologic tenderness in patients with tension headache is the source of nociception, but pain mechanisms are more complex, as evidenced by discrepancy between tenderness and pain in some patients. Pathologic tenderness should be a contributing criterion to the diagnosis of tension headache (muscle contraction headache).
Article
Recent interest in self-efficacy theory and pain has produced a variety of reports on the relationship between self-efficacy expectancies and pain perception and its management. In studies of behavioral treatment approaches, self-efficacy expectancies were found to be related to experimental and acute clinical pain tolerance. Efficacy beliefs were also found to be associated with the level of functioning of chronic pain patients and their response to treatment. These preliminary observations are promising and suggest that self-efficacy theory may contribute to the understanding and behavioral management of clinical pain.
Article
The present study attempted to identify psychological differences among different headache diagnoses defined by IHS criteria as well as psychological differences by headache intensity and frequency. Differences between diagnostic categories reflected characteristics used to assign diagnoses, namely the constancy of pain and distracting behaviors of significant others due to isolating behavior from photophobia and phonophobia. A rating of headache intensity and frequency was a more powerful predictor of psychological ratings than diagnosis. Diagnosis was related to headache frequency but not intensity. The results suggest that a continuum diagnosis based on severity can be useful in conceptualizing headaches, and a dual-diagnostic system integrating headache characteristics with perceptions and coping ability would be helpful in determining treatment options.
Article
SYNOPSIS The pathogenetic mechanism of tension headache (TH) is still unknown. The role of pericranial muscle tension in TH is also enigmatic. To evaluate this factor in chronic TH, pericranial muscles were paralysed in 6 chronic TH patients, using botulinum toxin. All patients fulfilled the IHS criteria of chronic TH associated with involvement of the pericranial muscles, but not the current criteria for cervicogenic headache. The patients were followed-up regularly with evaluation of the paralysis, changes in pain intensity, and pressure pain threshold measurements. We primarily only injected the temporal muscle on the one side, using the other side as a control. Contralateral muscles were in some cases injected at a later stage. In our study, we did not find any significant reduction in pain intensity, as measured by the visual analogue scale, nor any changes in pressure pain threshold, as measured by an algometer. On the basis of our observations, we conclude that muscle tension in these muscles possibly plays a minor role in the genesis of chronic TH. In our study, however, we have only treated a limited number of patients, and only one pericranial muscle has been injected systematically. Further studies of various neck/posterior head muscles ought to be performed in order to further evaluate a possible effect of tension in the pericranial musculature in producing this type of pain.
Article
SYNOPSIS Approximately 10% of adults suffer from severe or disabling headaches. For many patients, headaches are reduced with traditional medical, physical, or psychological therapies. However, a significant minority continue to report debilitating headaches despite the use of these conventional therapies. An integrated, interdisciplinary approach combining these three individual components in a group treatment setting was offered to patients who had failed previous therapy. The interdisciplinary treatment resulted in over 70% of patients experiencing a 50% or better reduction in headaches at follow‐up of an average of 5.8 months. Overall, there was an average reduction in medication use at follow‐up of 71%. The treated group reported significantly greater reduction in headache activity and medication consumption compared to a group that was referred to but did not receive group treatment. The results suggest that an interdisciplinary outpatient group treatment may provide a cost‐effective end time‐efficient treatment option for patients with a variety of recurring headaches, even if they have failed conventional therapies that use medical, physical, and psychological treatments individually.
Article
SYNOPSIS In this prospective controlled study, thirty-seven migraine and/or tension headache patients andthirty-seven age and sex matched controls were examined for evidence of muscuIoskeletal dysfunction inthe neck. The examination consisted of clinical range of motion testing of neck rotation, sidebending,flexion and extension while in the sitting position. The headache group had more abnormal physicalfindings than the control group. Although the difference for each particular motion test, taken by itself, wasnot statistically significant, two or more abnormalities in combination was found to reach a .05 confidencelevel of significance. It is proposed therefore that musculoskeletal dysfunction of the neck is a contributingfactor to the etiology of migraine and tension headache.
Article
In this study, 60 female subjects, aged between 25 and 40 years, were divided into two equal groups on the basis of absence or presence of headache. A passive accessory intervertebral mobility (PAIVM) examination was performed to confirm an upper cervical articular cause of the subjects' headache and a questionnaire was used to establish a profile of the headache population. Measurements of cranio-cervical posture and isometric strength and endurance of the upper cervical flexor muscles were compared between the two groups of subjects. The headache group was found to be significantly different from the non-headache group in respect to forward head posture (FHP) (t = -5.98, p < 0.00005), less isometric strength (t = 3.43, p < 0.001) and less endurance (t = 8.71, p < 0.0005) of the upper cervical flexors. A statistically significant relationship was also established between natural head posture and isometric endurance of the upper cervical flexor musculature which demonstrated that FHP corresponded with a low endurance capacity (chi 2 = 13.2; p < 0.01). The outcome of this study highlights the need to screen for cervical etiology in patients who are suspected of suffering from common migraine.
Article
It has been suggested that patients' perceptions of the impact chronic headache has on their lives as well as perceived control of their headaches may be associated with the intensity, duration, and exacerbation of pain they experience. The present study examined associations among International Headache Society (IHS) diagnostic category, pain characteristics such as severity and duration, perceived impact and control of headaches, and adaptive response. Two hundred twenty-five patients with migraine, tension-type, or combined migraine and tension-type headache served as subjects. General activity level was related to IHS diagnosis, with migraine headache patients reporting that they are more active than tension-type headache patients (F(2, 196) = 5.69, P < .01). Headache locus of control was not significantly related to IHS diagnosis, however external headache locus of control was significantly related to headache intensity (r = .32, P < .001, r = .25, P < .001), as well as to patients' perceptions of the extent to which pain interfered with various domains of their lives (r = .33, P < .001, r = .28, P < .001), and adaptive response (F(6, 402) = 4.68, P < .001). It appeared that perceived control over headaches and perceived impact of headaches were not related to IHS diagnostic category and were not strongly related to each other, but were related to headache severity.
Article
To review the literature on outcome studies of chiropractic/manipulation for tension-type and migraine headaches. Qualitative literature review. Of nine studies of manipulation for tension-type headaches that reported quantitative outcomes, four were randomized clinical trials and five were case series designs. These studies reported on 729 subjects, 613 of whom received manipulation. Outcomes ranged from good to excellent. Manipulation seems to be better than no treatment, some types of mobilization and ice, and it seems to be equivalent to amitriptyline but with greater durability of effect than this medication. Of three studies on migraine, only one was a randomized clinical trial. These studies reported on 202 subjects, 156 of whom received manipulation. The outcomes ranged from fair to very good. A modest body of clinical studies exists dealing with the effect of manipulation and headache. The overall results are encouraging, even if not quite supportive in the case of tension-type headache. Further studies in this area are definitely warranted, particularly well-controlled studies in migraine.
Article
Twenty patients with diagnosis of muscle contraction headache were treated for pain relief in a physical therapy clinic once a week for six visits. The previous 3-week period of no treatment served as a control period during which patients recorded by diary their headache frequency, duration, and intensity using a numeric pain scale. Activity level, as measured by the Sickness Impact Profile, and verbal reports of headache frequency, duration, and intensity were recorded at four points during a 1-year period. Measurements were recorded at precontrol, pretreatment, posttreatment, and 12-month follow-up. Treatment included education for posture at home and work place, isotonic home exercise, massage, and stretching to the cervical spine muscles. Results indicated frequency of headaches and Sickness Impact Profile scores were significantly improved (P < 0.001) over the course of treatment. These benefits were maintained after 12 months.