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Aydinlar EI, Dikmen PY, Kosak S, Kocaman AS. OnabotulinumtoxinA effectiveness on chronic migraine, negative emotional states and sleep quality: a single-center prospective cohort study. J Headache Pain 2017; 18:23. [PMID: 28213829 PMCID: PMC5315653 DOI: 10.1186/s10194-017-0723-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/13/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND OnabotulinumtoxinA (OnabotA) is considered effective in in patients with chronic migraine (CM) who failed on traditional therapies. This study was designed to evaluate the effect of OnabotA injection series on migraine outcome, negative emotional states and sleep quality in patients with CM. METHODS A total of 190 patients with CM (mean (SD) age: 39.3 (10.2) years; 87.9% were female) were included. Data on Pittsburgh sleep quality index (PSQI), headache frequency and severity, number of analgesics used, Migraine Disability Assessment Scale. (MIDAS) scores and Depression, Anxiety and Stress Scale (DASS-21) were evaluated at baseline (visit 1) and 4 consecutive follow up visits, each conducted after OnabotA injection series; at week 12 (visit 2), week 24 (visit 3), week 36 (visit 4) and week 48 (visit 5) to evaluate change from baseline to follow up. RESULTS From baseline to visit 5, significant decrease was noted in least square (LS) mean headache frequency (from 19.5 to 8.4, p = 0.002), headache severity (from 8.1 to 6.1, p = 0.017), number of analgesics (from 26.9 to 10.4, p = 0.023) and MIDAS scores (from 67.3 to 18.5, p < 0.001). No significant change from baseline was noted in global PSOI and DASS-21 scores throughout the study. CONCLUSIONS Our findings revealed that OnabotA therapy was associated with significant improvement in migraine outcome leading to decrease in headache frequency and severity, number of analgesics used and MIDAS scores. While no significant change was noted in overall sleep quality and prevalence of negative emotional states, patients without negative emotional states at baseline showed improved sleep quality throughout the study.
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Affiliation(s)
- Elif Ilgaz Aydinlar
- Department of Neurology, Acibadem University School of Medicine, Içerenkoy, Kayisdagi Cd, 34752 Atasehir/Istanbul, Turkey
| | - Pinar Yalinay Dikmen
- Department of Neurology, Acibadem University School of Medicine, Içerenkoy, Kayisdagi Cd, 34752 Atasehir/Istanbul, Turkey
| | - Seda Kosak
- Department of Neurology, Acibadem University School of Medicine, Içerenkoy, Kayisdagi Cd, 34752 Atasehir/Istanbul, Turkey
| | - Ayse Sagduyu Kocaman
- Department of Neurology, Acibadem University School of Medicine, Içerenkoy, Kayisdagi Cd, 34752 Atasehir/Istanbul, Turkey
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Rossi P, Di Lorenzo C, Faroni J, Cesarino F, Nappi G. Advice Alone Vs. Structured Detoxification Programmes for Medication Overuse Headache: A Prospective, Randomized, Open-Label Trial in Transformed Migraine Patients With Low Medical Needs. Cephalalgia 2016; 26:1097-105. [PMID: 16919060 DOI: 10.1111/j.1468-2982.2006.01175.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to compare the effectiveness of strong advice to withdraw the overused medication with the effectiveness of two structured pharmacological detoxification strategies in a cohort of patients diagnosed with probable migraine overuse headache (MOH) plus migraine and presenting low medical needs. One hundred and twenty patients participated in the study. Exclusion criteria included: previous detoxification treatments, coexistent medical or psychiatric illnesses and overuse of agents containing opioids, benzodiazepines and barbiturates. Group A received only intensive advice to withdraw the overused medication. Group B underwent a standard out-patient detoxification programme (advice + prednisone + preventive treatment). Group C underwent a standard inpatient withdrawal programme (as in group B + fluid replacement and antiemetics). Withdrawal therapy was considered successful if, after 2 months, the patient had reverted to an episodic pattern of headache and to an intake of symptomatic medication on fewer than 10 days/month. We were able to detoxify 75.4± of the whole cohort, 77.5± of patients in group A, 71.7± of patients in group B and 76.9± of those in group C ( P > 0.05). In patients with migraine plus MOH and low medical needs, effective drug withdrawal may be obtained through the imparting of advice alone.
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Affiliation(s)
- P Rossi
- Headache Clinic, INI Grottaferrata, Grottaferrata, Italy.
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Lauwerier E, Paemeleire K, Van Damme S, Goubert L, Crombez G. Medication use in patients with migraine and medication-overuse headache: the role of problem-solving and attitudes about pain medication. Pain 2011; 152:1334-1339. [PMID: 21396772 DOI: 10.1016/j.pain.2011.02.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 12/16/2010] [Accepted: 02/04/2011] [Indexed: 11/28/2022]
Abstract
Excessive medication intake is a risk factor for the development of medication-overuse headache (MOH), a condition characterized by an increase of headache frequency to a daily or near-daily pattern. As yet, it is largely unknown why some patients overuse medication. In this study, we examined to what extent attitudes about pain medication, especially perceived need and concerns, and problem-solving are related to MOH. Patients with migraine (n=133) and MOH with a history of migraine (n=42) were recruited from a tertiary headache referral center and completed questionnaires measuring problem-solving and attitudes about pain medication. A problem-solving mode aimed at solving pain was associated with a higher need for and concerns about medication intake. Interestingly, in a model accounting for demographic factors and pain intensity, attempts to control pain, need for medication, and concerns about scrutiny by others because of medication intake all had a unique value in accounting for MOH. Results are discussed in terms of how repeated attempts to solve pain may trigger overuse of medication, even in the presence of clear negative consequences. Repeated attempts at solving pain may increase the need for analgesic medication, despite obvious costs. This mechanism might contribute to the problem of medication-overuse headache.
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Affiliation(s)
- Emelien Lauwerier
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium Department of Neurology, Ghent University Hospital, Ghent, Belgium
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Smitherman TA, Penzien DB, Maizels M. Anxiety disorders and migraine intractability and progression. Curr Pain Headache Rep 2009; 12:224-9. [PMID: 18796274 DOI: 10.1007/s11916-008-0039-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Comorbid psychopathology has been implicated as a risk factor for the chronification and progression of migraine. Although past research has focused principally on depression and migraine, recent research consistently has confirmed that a disproportionate number of migraineurs suffer from one or more comorbid anxiety disorders. Moreover, this research has implicated anxiety disorders as factors potentially associated with migraine intractability and progression; growing evidence suggests that anxiety disorders may be even more prognostically significant than depression. This article summarizes these recent developments, considers mechanisms underlying this comorbidity, discusses strategies for assessing and managing comorbid anxiety, and notes directions for future clinical and empiric work.
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Affiliation(s)
- Todd A Smitherman
- Head Pain Center, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Allena M, Katsarava Z, Nappi G. From drug-induced headache to medication overuse headache. A short epidemiological review, with a focus on Latin American countries. J Headache Pain 2009; 10:71-6. [PMID: 19238511 PMCID: PMC3451648 DOI: 10.1007/s10194-009-0101-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Accepted: 01/20/2009] [Indexed: 12/03/2022] Open
Abstract
Medication overuse headache (MOH) is a daily or almost-daily type of headache that results from the chronicization, usually migraine or tension-type headache, as a consequence of the progressive increase of intake of symptomatic drugs. MOH is now the third most frequent type of headache and affects a percentage of 1-1.4% of the general population. The currently available data on the impact of chronic headache associated with analgesic overuse in specialist headache centres confirm, beyond doubt, the existence of a serious health problem. Limited amount of data exists on the burden and impact of MOH in Latin American Countries. In this review, we summarise the reliable information from the literature on the epidemiological impact of MOH.
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Affiliation(s)
- Marta Allena
- IRCCS Neurological Institute C. Mondino Foundation, University Centre for Headache and Adaptive Disorders, Pavia Section, Via Mondino 2, 27100 Pavia, Italy.
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Bruce BK, Townsend CO, Hooten WM, Rome JD, Moon JS, Swanson JW. Chronic pain rehabilitation in chronic headache disorders. Curr Pain Headache Rep 2009; 13:67-72. [PMID: 19126375 DOI: 10.1007/s11916-009-0014-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara K Bruce
- Mayo Clinic Department of Psychiatry and Psychology, Pain Rehabilitation Center, Mayo Clinic, Generose 2W, 200 First Street SW, Rochester, MN 55905, USA.
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Braden JB, Fan MY, Edlund MJ, Martin BC, DeVries A, Sullivan MD. Trends in use of opioids by noncancer pain type 2000-2005 among Arkansas Medicaid and HealthCore enrollees: results from the TROUP study. THE JOURNAL OF PAIN 2008; 9:1026-35. [PMID: 18676205 DOI: 10.1016/j.jpain.2008.06.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 05/30/2008] [Accepted: 06/06/2008] [Indexed: 11/19/2022]
Abstract
UNLABELLED Use of prescription opioids for noncancer pain has increased significantly in recent years, but it is not known if trends differ among the most common noncancer pain conditions. We examined trends in opioid prescribing for the years 2000 through 2005 for individuals with arthritis/joint pain, back pain, neck pain, and headaches by type and number of pain diagnoses, using data from claims records from 2 health insurers: HealthCore commercially insured members (N = 3,768,223) and Arkansas Medicaid (N = 127,866). Rates of headache, back pain, and neck pain diagnoses increased significantly in Arkansas Medicaid enrollees but more modestly among HealthCore enrollees. Rates of opioid use increased in both groups, with long-term use (>90 days' supply per year) increasing at twice the rate of any use. Rates of opioid use did not differ widely between noncancer pain conditions, but long-term opioid use rates doubled with each additional pain diagnosis. Mean days supply and cumulative yearly dose increased between 2000 and 2005 for all pain types and with increasing number of pain diagnoses, but dose per day supply remained relatively stable. The greatest increases in dose among all the pain conditions were seen in short-acting DEA Schedule II opioids. PERSPECTIVE This study demonstrates increased use of opioids, particularly long-term use, in noncancer pain over a 6-year period among those with multiple pain types. These results appear to reflect a general increase in use of prescription opioids for noncancer pain rather than a condition-specific change in prescribing practices.
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Affiliation(s)
- Jennifer Brennan Braden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195-6560 , USA.
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Saper JR. Chronic daily headache: Transformational migraine, chronic migraine, and related disorders. Curr Neurol Neurosci Rep 2008; 8:100-7. [DOI: 10.1007/s11910-008-0017-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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9
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Bruce BK, Townsend CO, Hooten WM, Rome JD, Moon JS, Swanson JW. Chronic pain rehabilitation in chronic headache disorders. Curr Neurol Neurosci Rep 2008; 8:94-9. [DOI: 10.1007/s11910-008-0016-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Couch JR, Lenaerts ME. Medication overuse headache: clinical features, pathogenesis and management. Drug Dev Res 2008. [DOI: 10.1002/ddr.20214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Radat F, Creac'h C, Guegan-Massardier E, Mick G, Guy N, Fabre N, Giraud P, Nachit-Ouinekh F, Lantéri-Minet M. Behavioral dependence in patients with medication overuse headache: a cross-sectional study in consulting patients using the DSM-IV criteria. Headache 2007; 48:1026-36. [PMID: 18081820 DOI: 10.1111/j.1526-4610.2007.00999.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to assess behavioral dependence on migraine abortive drugs in medication-overuse headache (MOH) patients and identify the predisposing factors. BACKGROUND It is common occurrence that MOH patients relapse after medication withdrawal. Behavioral determinants of medication overuse should therefore be identified in MOH patients. METHODS This was a cross-sectional, multicenter study that included 247 MOH patients (according to International Classification of Headache Disorders, 2nd edition criteria) consulting in French headache specialty centers. Face-to-face interviews were conducted by senior neurologists using a structured questionnaire including the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for the evaluation of dependence, Hospital Anxiety and Depression Scale for the evaluation of anxiety and depression, and 6-item short-form Headache Impact Test scale for the determination of functional impact. RESULTS Most MOH patients had pre-existing primary migraine (87.4%) and current migraine-type headaches (83.0%). Treatments overused included triptans (45.8%), opioid analgesics alone or in combination (43.3% of patients), and analgesics (27.9%). Nonmigraine abortive substances (tobacco, caffeine, sedatives/anxiolytics) were overused by 13.8% of patients. Two-thirds of MOH patients (66.8%) were considered dependent on acute treatments of headaches according to the DSM-IV criteria. Most dependent MOH patients had migraine as pre-existing primary headache (85.7%) and current migraine-type headaches (87.9%), and most of them overused opioid analgesics. More dependent than nondependent MOH patients were dependent on psychoactive substances (17.6% vs 6.1%). Multivariate logistic analysis indicated that risk factors of dependence on acute treatments of headaches pertained both to the underlying disease (history of migraine, unilateral headaches) and to drug addiction (opioid overuse, previous withdrawal). Affective symptoms did not appear among the predictive factors of dependence. CONCLUSION In some cases, MOH thus appears to belong to the spectrum of addictive behaviors. In clinical practice, behavioral management of MOH should be undertaken besides pharmacological management.
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Affiliation(s)
- Françoise Radat
- Department of Treatment of Chronic Pain Patients, Pellegrin University Hospital, Bordeaux, France
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Liu HC. Botulinum toxin type a as a prophylactic treatment for chronic daily headache: time to conduct a large clinical trial in Taiwan? J Chin Med Assoc 2007; 70:519-20. [PMID: 18194891 DOI: 10.1016/s1726-4901(08)70053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Freitag FG, Diamond S, Diamond M, Urban G. Botulinum Toxin Type A in the treatment of chronic migraine without medication overuse. Headache 2007; 48:201-9. [PMID: 18042229 DOI: 10.1111/j.1526-4610.2007.00963.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Chronic migraine is a recent diagnostic term that has undergone evolution from its original description. Clinically it has been believed that medication overuse contributed to its development and would block attempts at prevention. Previous studies with Botulinum Toxin Type A have demonstrated that it is effective even in patients with medication overuse. This study undertakes to examine the effects of Botulinum Toxin Type A in the absence of medication overuse in patients with chronic migraine. STUDY DESIGN Double-blind placebo-controlled randomized trial of Botulinum Toxin Type A 100 units administered in a fixed dose and site paradigm. PATIENTS In total, 86 patients were enrolled. A total of 60 patients were randomized and 41 patients were treated with the study medication or placebo. Five patients failed to complete the study, which lasted 4 months after the study medication was injected. RESULTS Botulinum Toxin Type A was statistically superior to placebo for the primary endpoint of reduction in migraine headache episodes. Six patients on Botulinum Toxin Type A compared with 3 patients on Placebo had at least a 50% reduction in their migraine episodes. Active treatment was superior to placebo for the secondary endpoints of total headache days, headache index, and quality of life measures. It showed numerical superiority to placebo for acute medication use and Migraine Disability Assessment Scores. Adverse events were rare and similar in both treatment groups. CONCLUSIONS The use of Botulinum Toxin Type A may be an effective treatment for chronic migraine when the patient does not have concomitant medication overuse. It was well tolerated in this trial.
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Dodick D, Freitag F. Evidence-based understanding of medication-overuse headache: clinical implications. Headache 2007; 46 Suppl 4:S202-11. [PMID: 17078852 DOI: 10.1111/j.1526-4610.2006.00604.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article discusses the problem of medication-overuse headache from a variety of perspectives, based on the best available evidence. This presentation clarifies the definition of the disorder, distinguishing it from alternative terminology, and describes its epidemiology, natural history, and clinical course. Antimigraine medications are believed to differ in their relative liability to contribute to the development of medication-overuse headache. Patients most at risk of developing medication-overuse headache need to be identified so that appropriate preventive measures can be initiated.
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Saper J. Stratification of Headache Care. Headache 2007; 47 Suppl 1:S23-5. [PMID: 17425707 DOI: 10.1111/j.1526-4610.2007.00674.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joel Saper
- Michigan Head-Pain and Neurological Institute, Ann Arbor, MI 48104, USA
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D'Amico D, Moschiano F, Bussone G. Early treatment of migraine attacks with triptans: a strategy to enhance outcomes and patient satisfaction? Expert Rev Neurother 2006; 6:1087-97. [PMID: 16831121 DOI: 10.1586/14737175.6.7.1087] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treating migraine attacks early with triptans may be more effective than late triptan administration. However, in published studies, the definition of 'early' varied (in terms of time, pain intensity or presence of allodynia) or was unclear. Therefore, clear clinical indications have not been established. Appropriately designed trials to address this issue remain a priority. Early triptan treatment may also have disadvantages, including inadvertent treatment of tension-type headaches and danger of medication overuse. At present, only those migraineurs with rapid pain worsening, high pain recurrence rate and clinical indications of allodynia should be encouraged to take triptans as quickly as possible. This recommendation implies a requirement for patient education and the need to carefully tailor treatment to individual needs.
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Affiliation(s)
- Domenico D'Amico
- C. Besta National Neurological Institute, Clinical Neurosciences Department, Via Celoria 11, 20133 Milano, Italy.
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Eun BL. Headaches in children and adolescents : diagnosis and treatment. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.4.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Baik-Lin Eun
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
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Branca B. Neuropsychologic aspects of post-traumatic headache and chronic daily headache. Curr Pain Headache Rep 2006; 10:54-66. [PMID: 16499831 DOI: 10.1007/s11916-006-0010-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The management of patients with chronic refractory head pain remains a treatment challenge. Treatment focus should be multidisciplinary as patients evolve into a deteriorated status with psychologic, social, vocational, and cognitive dysfunction. The neuropsychologist will gather premorbid and comorbid information, assess cognitive functioning, and be involved in every behavioral medicine and treatment decision. The patient with post-traumatic head pain copes with head injury sequelae. Issues related to worker's compensation, insurance, disability decisions, and litigation are intrinsic to these patient groups.
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Affiliation(s)
- Barbaranne Branca
- Michigan Head Pain and Neurological Institute, Ann Arbor, 48104, USA.
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