Integrated care for migraine and chronic tension-type headaches: A prospective observational study

Trends in complementary and alternative medicine for the treatment of common mental disorders: A bibliometric analysis of two decades

OBJECTIVE

To investigate the trend of scientific production in relation to the modalities of CAM adopted for the treatment of common mental disorders (CMD), and the evolution and distribution of relevant articles.

MATERIAL AND METHODS

A bibliometric analysis of studies published between 2001 and 2020 was performed, extracted from the Scopus database, using the terms: integrative medicine, complementary therapy, common mental disorders, anxiety and depression, and synonyms. The relationship between the number of publications, and the years studied were analyzed using Pearson's correlation, followed by linear regression to estimate the number of articles along with the year. The VOSviewer software was used to analyze scientometric data. The study looked at countries with the highest number of publications and citations, co-authorships, most frequent keywords, and leading research organizations.

RESULTS

In the analysis of the two decades, we identified a high positive correlation between the number of publications and year (r = 0.945). In trend analysis, the linear regression equation predicted the growth of publications along with the year, with R² = 0.8949 explaining most of the data variability. Spirituality was the most frequent term among the modalities. The concentration of publications and the number of citations were significantly higher in developed countries.

CONCLUSION

The rise in the number of publications in the past two decades on the application of CAM among individuals with CMD suggests a growing scientific interest in Integrative practices. These bibliometric indicators suggest that new studies are warranted, as well as improvements in public health policies.

Multidisciplinary headache clinic-impact of a new model for headache care in Dubai

INTRODUCTION

Primary headache disorders pose a huge burden to health systems around the world. A new model for headache care was introduced at two primary health centers (PHCs) in Dubai, UAE. Our objective is to describe the model, and the impact it had on increasing the number of patients receiving specialist care as well as on patient's response and satisfaction level.

METHODS

The model consisted of a weekly multi-disciplinary headache clinic with a neurologist, a general physician, a psychologist and a nurse, at each of the two PHCs. Patients were referred from all PHCs in Dubai. Follow up visits were either with the general physician or through tele-headache with the neurologist. We used the HURT questionnaire to evaluate the headache for each patient at baseline and then again at follow up. Information on patient satisfaction was also collected. Data were analyzed using SPSS version 21.

RESULTS

The model proved to be effective in terms of increase in the number of headache patients receiving specialist care. Using HURT questionnaire, improvement was seen in good control and in the sense of control over headache, and in risk of medication overuse between baseline and follow up visits. Patient satisfaction with various aspects of headache care was 80-90% after the first visit and improved further at follow up.

CONCLUSION

Our multi-disciplinary headache model improved the access of patients to neurologists, and resulted in improved headache control and patient satisfaction levels. Other countries can adopt such models to improve headache care for their patients.

Employee and Employer Benefits From a Migraine Management Program: Disease Outcomes and Cost Analysis

OBJECTIVE

To assess the impact of a migraine management program offered as a complimentary service by a company within its corporate well-being program.

BACKGROUND

Migraine imposes a substantial burden on patients, families, employers, and societies. As migraine primarily affects working-age adults, this has important implications for both employees and employers. Workplace educational and well-being programs positively contribute to employees' productivity, reduce costs related to absenteeism, and improve the quality of life of the employees living with migraine.

METHODS

This was a non-interventional cohort study, which followed employees and their family members over time. Participants received 1 telemedicine consultation to determine migraine diagnosis or a high probability of having migraine and 6 sessions of individualized telecoaching from a specialized nurse via a specially developed smartphone application to optimize their migraine management leveraging all appropriate medical and lifestyle options. Participants were evaluated during the program and at 3 months after completion through a series of validated questionnaires including Migraine Disability Assessment (MIDAS), Patient Activation Measure (PAM), and satisfaction with the services offered. A cost analysis was also performed to determine the economic benefit of the program considering the number of completers, dropouts, their associated program costs, MIDAS data, average salary of a Swiss employee in the pharma sector, and working days per year.

RESULTS

Of the 141 participants enrolled in the program, 79 completed 6-month and 42 completed 9-month assessments. The total MIDAS scores (mean, standard deviation [SD]) significantly improved from baseline by 54% at Month 6 (15.0 [13.6] vs 6.9 [8.2]; mean [SD] reduction: 8.1 [12.9], 95% confidence interval [CI]: 5.6-10.6; P < .0001) and by 64% at Month 9 (15.4 [14.7] vs 5.6 [6.0]; mean [SD] reduction: 9.8 [14.0], 95% CI: 6.6-13.0; P < .0001). The PAM scores also significantly improved from baseline by 8% at Month 6 (63.8 [10.9] vs 69.6 [12.8]; mean [SD] increase: 5.8 [12.8], 95% CI: 3.2-8.4; P = .003) and 11% at Month 9 (63.5 [10.7] vs 71.3 [12.2]; mean [SD] increase: 7.8 [11.0], 95% CI: 4.3-11.2; P = .003). At Month 6, common coaching lessons and respective action plans focused on progressive muscle relaxation, sleep, hydration, nutrition, general disease education, and stress management. The exit survey showed that the majority of the participants who completed the program had a meaningful and sustained improvement in their overall health and reported a high level of satisfaction with the program. The cost analysis revealed that on average participants gained 10.8 (95% CI: 9.3-12.3) working days/year that were previously lost due to migraine, resulting in a positive return on investment (ROI) of 490% (95% CI: 410%-570%), indicating a higher magnitude of savings that could be achieved by the implementation of such program. In addition to ROI and work productivity gained, participants also gained on average 13.6 (95% CI: 9.9-17.3) migraine-free days/year for their private and social life.

CONCLUSION

The employer-sponsored disease management program provided a better understanding of migraine, promoted methods and approaches to improve management by combining medical and lifestyle options leading to significant improvements in migraine symptoms that sustained beyond the intervention, supporting prolonged effectiveness of such programs. The program also provided a high ROI to the employer, supporting that the systematic inclusion of such programs into corporate well-being initiatives can be of significant benefit not only to the impacted individuals but to the employers as well.