Behavior Techniques Can Help Migraineurs

BY BRUCE K. DIXON
Elsevier Global Medical News

SCOTTSDALE, ARIZ. (EGMN) NOV. 11, 2006 - Persistent misconceptions and other barriers to behavioral therapy limit headache patients' access to potentially beneficial non-pharmacologic treatments, Donald B. Penzien, Ph.D., said at the annual meeting of the American Headache Society.

Standard behavioral interventions include relaxation training, biofeedback training, cognitive behavioral therapy, stress management, or some combination of these approaches, said Dr. Penzien, professor of psychiatry and director of the Head Pain Center at the University of Mississippi.

While reimbursement and workforce issues limit the use of these non-pharmacologic treatments, another factor weighs heavily as well: the stigma of seeking care from a behavioral specialist, according to Dr. Penzien.

"The reality is that patients with migraine or tension headache don't necessarily have emotional illness, yet research shows they can still benefit from behavioral therapy," he said in an interview.

Even the best pharmacologic agents have their limits because headache is a psychophysiological disorder, explained Dr. Penzien.

Patients most suitable for behavioral headache treatments include those with poor tolerance of and medical contraindications for drug treatment, inadequate response to medications, those who prefer non-drug interventions, pregnancy and nursing women, and those with history of frequent or excessive use of analgesic or other acute medications.

"Over 300 studies have evaluated behavioral therapy for the management of migraine. On average, these interventions have shown 35%-55% improvement pretreatment to post treatment," Dr. Penzien said.

Furthermore, he added, the effects of behavioral treatments appear to endure; the literature shows efficacy in follow-up up to 7 years post-treatment.

Behavioral treatment typically entails 6 to 12 clinic sessions with a professional. Cost and time considerations have given rise to the minimal therapist contact (MTC) approach, which require fewer sessions.

MTC interventions are started at the clinic and patients are then sent home with reading and audio materials that guide their acquisition of new behavioral skills on their own time, Dr. Penzien explained.

"Minimal contact therapies are producing results in the range of what we can do with the more intensive clinic-based therapies. The patients appreciate the convenience and lower cost."

© Copyright 2007 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the copyright owner. No responsibility is assumed by the Publisher for any injury and/or damage to persons or property as a matter of products liability, through negligence or otherwise or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Because of rapid advances in the medical sciences, the Publisher recommends that independent verification f diagnoses and drug dosages should be made. Opinions expressed in this publication are those of the original authors and do not necessarily reflect those of the publisher, the sponsor, or the editors, Elsevier assumes no liability for any material published herein.