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Chen H, Yang N, Lan J, Jiang M, Ying Q, Dai Z, Wang K, Xiao Q. A study of the development path of key disciplines in the Guang'an hospital based on construction of west China's compact medical consortium hospitals. Am J Transl Res 2021; 13:10469-10476. [PMID: 34650716 PMCID: PMC8507059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the development path of key disciplines in Guang'an Hospital based on the construction of West China's compact medical consortium hospitals. METHODS The urological medical staff and facilities in Guang'an Hospital were selected as the study subjects. The urological medical staff were interviewed, and a detailed investigation and analysis of the current development of urology and the allocation of experts and medical equipment and resources were performed, so as to promote the development of key disciplines in Guang'an Hospital. RESULTS We aim to focus on the operational targets of the compact medical consortium while remaining committed to the construction of disciplines of urology. Meanwhile, the relationship between patients and health care providers was coordinated in regard to health care services. The mean of compactness of the dimensions involved in the targets of the operational body of patients was 4.71, while that of the improvement of the medical and health environment was 4.88. The allocated proportion of healthcare resources was optimized, and the operational efficiency was improved. If an excellent medical service experience was provided, the obtained data are statistically significant. CONCLUSION Based on the medical consortium, the assessment model of scientific experimental methods, and with the goal of improving the quality of medical treatment regarding urology, the responsibilities of urologists are further defined. A standardized training plan was conducted, with assessment systems of disciplines and better access systems of urologists are formulated and improved, and therefore the construction of key disciplines is promoted, thereby providing more references for the construction and development of key disciplines of urology.
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Affiliation(s)
- Hua Chen
- Department of Urology, Guang’an People’s HospitalGuang’an 638000, Sichuan, China
| | - Ning Yang
- Guang’an People’s HospitalGuang’an 638000, Sichuan, China
| | - Jianhua Lan
- Department of Urology, Guang’an People’s HospitalGuang’an 638000, Sichuan, China
| | - Mingyong Jiang
- Emergency Department, Guang’an Traditional Chinese Medicine HospitalGuang’an 638000, Sichuan, China
| | - Qiao Ying
- Department of Urology, Guang’an People’s HospitalGuang’an 638000, Sichuan, China
| | - Zhuling Dai
- Department of Urology, Guang’an People’s HospitalGuang’an 638000, Sichuan, China
| | - Kunjie Wang
- West China Hospital of Sichuan UniversityChengdu 610041, Sichuan, China
| | - Qiqiang Xiao
- Institute of Hospital Management, West China Hospital of Sichuan UniversityChengdu 610041, Sichuan, China
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Martínez-Pías E, Guerrero ÁL, Sierra Á, Trigo J, García-Azorín D. Daily Headache in Chronic Migraine Is a Predictive Factor of Response in Patients Who Had Completed Three Sessions of OnabotulinumtoxinA. Toxins (Basel) 2021; 13:toxins13060432. [PMID: 34205832 PMCID: PMC8234385 DOI: 10.3390/toxins13060432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 01/03/2023] Open
Abstract
OnabotulinumtoxinA is one of the main preventive treatments for chronic migraine. Despite that up to one third of patients with chronic migraine suffer from daily headache, these individuals have hardly been studied. We conducted a prospective cohort study, including patients with chronic migraine and treated with OnabotulinumtoxinA according to the PREEMPT paradigm. The primary endpoint was to assess whether patients with chronic migraine and daily headache had a different response after three sessions of OnabotulinutoxinA than patients without daily headache. The secondary endpoint was to analyse the presence of predictive factors that could be associated with a higher response to OnabotulinumtoxinA. Patients with daily headache had a reduction of 14.9 (SD: 9.7) headache days per month, patients with 22–29 headache days a reduction of 10.6 (SD: 9.9) days, and patients with 15–21 headache days a reduction of 8.6 (SD: 7.1) days (p < 0.001). In the univariate regression analysis, a higher number of headache days per month at baseline was associated with higher odds of reduction in the number of headache days per month after OnabotulinumtoxinaA treatment (OR: 0.474, 95% CI: 0.278–0.670, p < 0.001). This association was maintained in the multivariate regression analysis (OR: 0.540, 95% CI: 0.333–0.746, p < 0.001). In our sample, daily headache was not associated with a worse response to OnabotulinumtoxinA treatment. A higher frequency of headache at baseline was a predictor of better response to OnabotulinumtoxinA treatment.
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Affiliation(s)
- Enrique Martínez-Pías
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (E.M.-P.); (Á.S.); (J.T.); (D.G.-A.)
| | - Ángel L. Guerrero
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (E.M.-P.); (Á.S.); (J.T.); (D.G.-A.)
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
- Department of Medicine, University of Valladolid, 47005 Valladolid, Spain
- Correspondence: ; Tel.: +34-630981360; Fax: +34-983257511
| | - Álvaro Sierra
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (E.M.-P.); (Á.S.); (J.T.); (D.G.-A.)
| | - Javier Trigo
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (E.M.-P.); (Á.S.); (J.T.); (D.G.-A.)
| | - David García-Azorín
- Headache Unit, Neurology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (E.M.-P.); (Á.S.); (J.T.); (D.G.-A.)
- Institute for Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
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Yuan D, Zhang Y, Li Q, Lv Y, Li X, Yu Y, Li W, Tan G. Factors Affecting Preventive Treatment Outcomes for Patients With Newly Diagnosed Chronic Migraine and Their Compliance With Treatment Recommendations in Chongqing Province, China: An Open-Label Prospective Study With Retrospective Baseline. Front Neurol 2020; 11:227. [PMID: 32328024 PMCID: PMC7161669 DOI: 10.3389/fneur.2020.00227] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 03/10/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dongli Yuan
- Department of Intelligent Medical Systems, Institute of Medical Information, Chongqing Medical University, Chongqing, China
| | - Yixin Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Li
- Department of Neurology, Chongqing Zhongshan Hospital, Chongqing, China
| | - Yuhua Lv
- Department of Neurology, Chongqing Banan Hospital, Chongqing, China
| | - Xuelian Li
- Department of Neurology, Chongqing Hechuan District Hospital, Chongqing, China
| | - Yichuan Yu
- Department of Neurology, Chongqing Yongchuan District Hospital, Chongqing, China
| | - Wangwen Li
- Department of Neurology, Chongqing Sanxia Center Hospital, Chongqing, China
| | - Ge Tan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Ge Tan
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Kocasoy orhan E. Current Approach to Medication Overuse Headache. Noro Psikiyatr Ars 2019; 56:233-234. [PMID: 31903028 PMCID: PMC6927090 DOI: 10.29399/npa.24908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023] Open
Affiliation(s)
- Elif Kocasoy orhan
- İstanbul University, İstanbul Medical Faculty, Department of Neurology, İstanbul, Turkey
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5
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Cramer H, Hehlke M, Vasmer J, Rampp T, Anheyer D, Saha FJ, Paul A, Lauche R, Dobos G. Integrated care for migraine and chronic tension-type headaches: A prospective observational study. Complement Ther Clin Pract 2019; 36:1-6. [DOI: 10.1016/j.ctcp.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/19/2019] [Accepted: 04/10/2019] [Indexed: 01/03/2023]
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Kristoffersen ES, Faiz KW, Winsvold BS. Neurology residents' knowledge of the management of headache. Cephalalgia 2019; 39:1396-1406. [PMID: 31067081 DOI: 10.1177/0333102419847973] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In Norway, as in most other countries, the training program for clinical neurology has no mandatory headache program. Knowledge in headache management must therefore be acquired during everyday clinical training. The objectives of this study were to investigate neurology residents' knowledge of headache. METHODS A questionnaire survey was undertaken among neurology residents in Norway. RESULTS All 17 neurological departments in Norway participated, and 143 residents responded (86%). Sixty percent were women, mean age was 32.5 years, and the respondents had an average of 28 months clinical training in neurology. Fifty-six percent knew the approximate prevalence of migraine and chronic headache. Thirty-seven percent asked their patients about disability, quality of life, and social functioning at every consultation. Further, 72% would prescribe prophylaxis for chronic tension-type headache and 97% for very frequent migraine. One third wrongly stated that use of the most common headache prophylactics could lead to medication-overuse headache. Headache diaries were used regularly by 63% for diagnostic purposes, and 73% requested an MRI for all long-lasting headaches referred to neurological outpatient clinics. CONCLUSION Although a major public health problem, headache knowledge is moderate at best, and its management clearly varies. There is an unmet need for a better and more structured headache training program in Norway.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Department of General Practice, HELSAM, University of Oslo, Oslo, Norway.,FORMI, Oslo University Hospital, Oslo, Norway
| | - Kashif Waqar Faiz
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Bendik Slagsvold Winsvold
- FORMI, Oslo University Hospital, Oslo, Norway.,Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Kropp P, Meyer B, Dresler T, Fritsche G, Gaul C, Niederberger U, Förderreuther S, Malzacher V, Jürgens TP, Marziniak M, Straube A. [Relaxation techniques and behavioural therapy for the treatment of migraine : Guidelines from the German Migraine and Headache Society]. Schmerz 2019; 31:433-447. [PMID: 28364171 DOI: 10.1007/s00482-017-0214-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Besides pharmacological and interventional possibilities nonpharmacological options, deriving from behavioural approaches may be helpful in the treatment of migraine. Already consulting a patient reduces frequency of attacks. Relaxation (especially progressive muscle relaxation), endurance sports, and biofeedback as well as cognitive behavioural therapy are effective in treatment of migraine. The combination of these treatment options also with pharmacological treatment increase the positive effects.
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Affiliation(s)
- P Kropp
- Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Deutschland.
| | - B Meyer
- Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Deutschland
| | - T Dresler
- Klinik für Psychiatrie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland.,Graduiertenschule & Forschungsnetzwerk LEAD, Universität Tübingen, Tübingen, Deutschland
| | - G Fritsche
- Klinik für Neurologie, Universitätsklinikum Essen, Essen, Deutschland
| | - C Gaul
- Migräne- und Kopfschmerz Klinik Königstein, Königstein im Taunus, Deutschland
| | - U Niederberger
- Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - S Förderreuther
- Neurologie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - V Malzacher
- Neurologische Praxis, Reutlingen, Deutschland
| | - T P Jürgens
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - M Marziniak
- Klinik für Neurologie, Zentrum für Neurologische Intensivmedizin, kbo-Isar-Amper-Klinikum München-Ost, München, Deutschland
| | - A Straube
- Neurologie, Ludwig-Maximilians-Universität München, München, Deutschland
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Kristoffersen ES, Grande RB, Aaseth K, Russell MB, Lundqvist C. Medication-overuse headache detoxification reduces headache disability - the Akershus study of chronic headache. Eur J Neurol 2018; 25:1140-1147. [DOI: 10.1111/ene.13674] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/03/2018] [Indexed: 12/01/2022]
Affiliation(s)
- E. S. Kristoffersen
- Head and Neck Research Group, Research Centre; Akershus University Hospital; Lørenskog Norway
- Department of General Practice; HELSAM; University of Oslo; Oslo Norway
- Department of Neurology; Akershus University Hospital; Lørenskog Norway
| | - R. B. Grande
- Head and Neck Research Group, Research Centre; Akershus University Hospital; Lørenskog Norway
- National Center for Epilepsy; Oslo University Hospital; Oslo Norway
| | - K. Aaseth
- Head and Neck Research Group, Research Centre; Akershus University Hospital; Lørenskog Norway
- Department of Neurology; Akershus University Hospital; Lørenskog Norway
| | - M. B. Russell
- Head and Neck Research Group, Research Centre; Akershus University Hospital; Lørenskog Norway
- Institute of Clinical Medicine; Campus Akershus University Hospital; University of Oslo; Lørenskog Norway
| | - C. Lundqvist
- Head and Neck Research Group, Research Centre; Akershus University Hospital; Lørenskog Norway
- Department of Neurology; Akershus University Hospital; Lørenskog Norway
- Institute of Clinical Medicine; Campus Akershus University Hospital; University of Oslo; Lørenskog Norway
- Health Services Research Centre; Akershus University Hospital; Lørenskog Norway
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Kainth P, Murphy N, Rossi S, Talabardon JN, Pedrazzoli M, Mascagni L, Menarini I. Management of Migraine and the Accessibility of Specialist Care – Findings from a Multi-national Assessment of 28 Healthcare Networks. ACTA ACUST UNITED AC 2018. [DOI: 10.17925/enr.2018.13.2.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction:Migraine is one of the leading reasons for patient access to neurology services. Waiting lists can limit patients’ ability to access specialist care, even at specialised headache centres. Our study aims to investigate this issue, identify possible root causes and also document existing good practices.Methods:We conducted a study in a sample of 28 headache centres and their networks in six countries by performing in-depth interviews with 166 healthcare professionals.Results:The waiting list for new patients and follow-up visits exceeded 3 months in 61% and 36% of centres, respectively. Patients waited on average 6 months for their first consultation, with peaks beyond 12 months. Five areas were identified as common rootcauses:(1) inappropriate referral of patients with low-frequency episodic migraine or patients under acute treatment, (2) lack of triage/priority allocation, (3) limited resource availability or resources dedicated to migraine, (4) limited delegation of activities, and (5) suboptimal management of follow-up visits.Conclusion:Our work highlights a gap between best practices for migraine management proposed in the literature and current real-world practice. Guidelines recommend a network approach to bridge different levels of care. Based on our findings, consistency in practice amongst specialised headache clinics and integration with primary care represent an important area for further improvement.
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Kropp P, Meyer B, Meyer W, Dresler T. An update on behavioral treatments in migraine - current knowledge and future options. Expert Rev Neurother 2017; 17:1059-1068. [PMID: 28877611 DOI: 10.1080/14737175.2017.1377611] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Besides pharmacological and interventional treatments a variety of non-medical therapeutic options exist for migraine, which has largely been derived from behavioral therapy. Areas covered: For our update we collected available studies via PubMed searches. This review highlights that already consulting of the patient is able to reduce the frequency of migraine attacks. Relaxation techniques, especially progressive muscle relaxation, and various types of biofeedback are effective, as is the implementation of cognitive behavioral therapy. However, recent reviews also point to some existing inconsistencies and methodological limitations. The advent of modern information technology based approaches (e.g. online therapy, smartphone applications) further advanced the arsenal of behavioral treatment regimes. The combination of behavioral treatment options and the combination with pharmacotherapy lead to additive effects. In modern multidisciplinary treatment approaches, behavioral therapy is an indispensable component. Expert commentary: Behavioral treatment in prophylaxis of migraine is as effective as pharmacological treatment with additional effects when pharmacological and behavioral treatment is applied in combination. Novel treatment approaches using online technology and electronic devices offer interesting options that will spread more in the future.
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Affiliation(s)
- Peter Kropp
- a Institute of Medical Psychology and Medical Sociology , University Medicine Rostock , Rostock , Germany
| | - Bianca Meyer
- a Institute of Medical Psychology and Medical Sociology , University Medicine Rostock , Rostock , Germany
| | - Wolfgang Meyer
- b Barts and the London School of Medicine and Dentistry , Queen Mary University of London , London , United Kingdom
| | - Thomas Dresler
- c Department of Psychiatry & Psychotherapy , University Hospital Tuebingen , Tuebingen , Germany.,d LEAD Graduate School & Research Network , University of Tuebingen , Tuebingen , Germany
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Probyn K, Bowers H, Caldwell F, Mistry D, Underwood M, Matharu M, Pincus T. Prognostic factors for chronic headache: A systematic review. Neurology 2017; 89:291-301. [PMID: 28615422 PMCID: PMC5513814 DOI: 10.1212/wnl.0000000000004112] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/15/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To identify predictors of prognosis and trial outcomes in prospective studies of people with chronic headache. METHODS This was a systematic review of published literature in peer-reviewed journals. We included (1) randomized controlled trials (RCTs) of interventions for chronic headache that reported subgroup analyses and (2) prospective cohort studies, published in English, since 1980. Participants included adults with chronic headache (including chronic headache, chronic migraine, and chronic tension-type headache with or without medication overuse headache). We searched key databases using free text and MeSH terms. Two reviewers independently extracted data and assessed the methodologic quality of studies and overall quality of evidence identified using appropriate published checklists. RESULTS We identified 16,556 titles, removed 663 duplicates, and reviewed 199 articles, of which 27 were included in the review-17 prospective cohorts and 10 RCTs with subgroup analyses reported. There was moderate-quality evidence indicating that depression, anxiety, poor sleep and stress, medication overuse, and poor self-efficacy for managing headaches are potential prognostic factors for poor prognosis and unfavorable outcomes from preventive treatment in chronic headache. There was inconclusive evidence about treatment expectations, age, age at onset, body mass index, employment, and several headache features. CONCLUSIONS This review identified several potential predictors of poor prognosis and worse outcome postinterventions in people with chronic headache. The majority of these are modifiable. The findings also highlight the need for more longitudinal high-quality research of prognostic factors in chronic headache.
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Affiliation(s)
- Katrin Probyn
- From the Department of Psychology (K.P., H.B., F.C., T.P.), Royal Holloway, University of London; Warwick Clinical Trials Unit (D.M., M.U.), Warwick Medical School, University of Warwick, Coventry; and Headache Group (M.M.), Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Hannah Bowers
- From the Department of Psychology (K.P., H.B., F.C., T.P.), Royal Holloway, University of London; Warwick Clinical Trials Unit (D.M., M.U.), Warwick Medical School, University of Warwick, Coventry; and Headache Group (M.M.), Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Fiona Caldwell
- From the Department of Psychology (K.P., H.B., F.C., T.P.), Royal Holloway, University of London; Warwick Clinical Trials Unit (D.M., M.U.), Warwick Medical School, University of Warwick, Coventry; and Headache Group (M.M.), Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Dipesh Mistry
- From the Department of Psychology (K.P., H.B., F.C., T.P.), Royal Holloway, University of London; Warwick Clinical Trials Unit (D.M., M.U.), Warwick Medical School, University of Warwick, Coventry; and Headache Group (M.M.), Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Martin Underwood
- From the Department of Psychology (K.P., H.B., F.C., T.P.), Royal Holloway, University of London; Warwick Clinical Trials Unit (D.M., M.U.), Warwick Medical School, University of Warwick, Coventry; and Headache Group (M.M.), Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Manjit Matharu
- From the Department of Psychology (K.P., H.B., F.C., T.P.), Royal Holloway, University of London; Warwick Clinical Trials Unit (D.M., M.U.), Warwick Medical School, University of Warwick, Coventry; and Headache Group (M.M.), Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Tamar Pincus
- From the Department of Psychology (K.P., H.B., F.C., T.P.), Royal Holloway, University of London; Warwick Clinical Trials Unit (D.M., M.U.), Warwick Medical School, University of Warwick, Coventry; and Headache Group (M.M.), Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Krause SJ, Stillman MJ, Tepper DE, Zajac D. A Prospective Cohort Study of Outpatient Interdisciplinary Rehabilitation of Chronic Headache Patients. Headache 2017; 57:428-440. [PMID: 28127753 DOI: 10.1111/head.13020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/08/2016] [Accepted: 11/08/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the efficacy of an intensive outpatient program designed to improve functioning and reduce psychological impairment in chronic headache patients. BACKGROUND Chronic headaches, occurring 15 or more days per month, for three or more months, may arise from multiple International Classification of Headache Disorders diagnoses: Chronic Migraine, Chronic Tension Type Headache, New Daily Persistent Headache, Chronic Post Traumatic Headaches, and Medication Overuse Headache. Several interdisciplinary programs that treat patients with chronic headaches have reported decreases in headache frequency. This study sought to evaluate the effect of a 3 week interdisciplinary treatment program for patients with chronic headache disorders on headache severity, functional status, and psychological impairment. METHODS Subjects were 379 patients admitted to an outpatient chronic headache treatment program. Assessments of headache severity, psychological status, and functional impairment were completed by 371 (97.8%) of these at the time of admission. At discharge, 340 subjects (89.7%) provided assessment data, and 152 (40.1%) provided data at 1-year follow-up. RESULTS Subjects' mean ratings on a 0-10 scale for their headache pain in the prior week declined, and these improvements were maintained at follow-up. (Estimated marginal means on a 0-10 scale for Average pain: admission 6.1, discharge 3.5, follow-up 3.3; for Least pain: admission 3.2; discharge 1.5; follow-up 1.3; for Worst pain: admission 8.2; discharge 6.4; follow-up 5.7), and similar results were found for current pain (admission 4.7; discharge 2.8; follow-up 2.4): Measures of functional impairment also improved following treatment, and these gains were maintained at 12 month follow up (Estimated marginal mean Headache Impact Test-6 score: admission 66.1, discharge 55.4, follow-up 51.9; Estimated marginal mean Pain Disability Index score: admission 36.2, discharge 14.1, follow-up 11.6). As measured by the Depression, Anxiety and Stress Scale, anxiety and reactivity to stress decreased following treatment, and remained improved at follow-up (Estimated marginal mean score for Anxiety: admission 8.7, discharge 5.2, follow-up 4.4; Estimated marginal mean score for stress: admission 14.9, discharge 7.2, follow-up 7.6). Depression decreased with treatment, but while 1-year follow-up depression scores remained significantly lower than at admission, they were also significantly higher than at discharge (Estimated marginal means: admission 13.3, discharge 4.1, follow-up 6.6). CONCLUSIONS The study supports the efficacy of the treatment model. Limitations of the study and suggestions for future research are also discussed.
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Affiliation(s)
- Steven J Krause
- Department of Psychiatry & Psychology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mark J Stillman
- Department of Neurology, the Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Deborah E Tepper
- Department of Internal Medicine, Beth Israel Deaconess Healthcare, Sandwich, MA, USA
| | - Deborah Zajac
- Department of Nursing, Houston Methodist Hospital, Houston, TX, USA
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14
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Tassorelli C, Jensen R, Allena M, De Icco R, Katsarava Z, Miguel Lainez J, Leston JA, Fadic R, Spadafora S, Pagani M, Nappi G. The added value of an electronic monitoring and alerting system in the management of medication-overuse headache: A controlled multicentre study. Cephalalgia 2016; 37:1115-1125. [DOI: 10.1177/0333102416660549] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Medication-overuse headache (MOH) is a chronic disabling condition associated with a high rate of relapse. Methods We evaluated whether the adoption of electronic-assisted monitoring, advice and communication would improve the outcome over a follow-up of 6 months in a controlled, multicentre, multinational study conducted in six headache centres located in Europe and Latin America. A total of 663 MOH subjects were enrolled and divided into two groups: the Comoestas group was monitored with an electronic diary associated with an alert system and a facilitated communication option, and the Classic group with a paper headache diary. Results We observed a significantly higher percentage of overuse-free subjects in the Comoestas group compared with the Classic group: 73.1 vs 64.1% (odds ratio 1.45, 95% confidence interval 1.07–2.09, p = 0.046). The Comoestas group performed better also regarding the number of days/month with intake of acute drugs and the level of disability [Migraine Disability Assessment Score: Comoestas group – 42.5 ± 53.6 (35.5–49.3) and Classic group – 27.5 ± 56.1 (20.6–34.3) ( p < 0.003)]. Conclusion The adoption of the electronic tool improved the outcome of patients suffering from MOH after withdrawal from overused drugs. Information and communication technology represents a valid aid for optimizing the management of chronic conditions at risk of worsening or of relapsing. Trial registration The trial was registered at ClinicalTrials.gov (no. NCT02435056).
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Affiliation(s)
- Cristina Tassorelli
- Headache Science Centre, C. Mondino National
Neurological Institute, Pavia, Italy
- Department of Brain and Behavioral Sciences,
University of Pavia, Italy
| | - Rigmor Jensen
- Danish Headache Centre, Department of
Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen,
Denmark
| | - Marta Allena
- Headache Science Centre, C. Mondino National
Neurological Institute, Pavia, Italy
| | - Roberto De Icco
- Headache Science Centre, C. Mondino National
Neurological Institute, Pavia, Italy
- Department of Brain and Behavioral Sciences,
University of Pavia, Italy
| | | | - J Miguel Lainez
- Foundation of the Valencian Community,
University Clinical Hospital, Spain
| | - Jorge A Leston
- Foundation for Combatting Neurological
Diseases of Childhood, Buenos Aires, Argentina
| | - Ricardo Fadic
- Department of Neurology, Pontificia Catolica
University of Chile, Santiago, Chile
| | | | - Marco Pagani
- Bioengeneering and Medical Informatics
Consortium (CBIM), Pavia, Italy
| | - Giuseppe Nappi
- Headache Science Centre, C. Mondino National
Neurological Institute, Pavia, Italy
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15
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Abstract
Chronic daily headache (CDH) is a group of headache disorders, in which headaches occur daily or near-daily (>15 days per month) and last for more than 3 months. Important CDH subtypes include chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Other headaches with shorter durations (<4 h/day) are usually not included in CDH. Common comorbidities of CDH are medication overuse headache and various psychiatric disorders, such as depression and anxiety. Indications of inpatient treatment for CDH patients include poor responses to outpatient management, need for detoxification for overuse of specific medications (particularly opioids and barbiturates), and severe psychiatric comorbidities. Inpatient treatment usually involves stopping acute pain, preventing future attacks, and detoxifying medication overuse if present. Multidisciplinary integrated care that includes medical staff from different disciplines (e.g., psychiatry, clinical psychology, and physical therapy) has been recommended. The outcomes of inpatient treatment are satisfactory in terms of decreasing headache intensity or frequency, withdrawal from medication overuse, reducing disability, and improving life quality, although long-term relapse is not uncommon. In conclusion, inpatient treatment may be useful for select patients with refractory CDH and should be incorporated in a holistic headache care program.
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16
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Göbel H, Heinze-Kuhn K, Petersen I, Göbel C, Göbel A, Heinze A. [Classification and therapy of medication-overuse headache: impact of the third edition of the International Classification of Headache Disorders]. Schmerz 2015; 28:191-204; quiz 205-6. [PMID: 24718751 DOI: 10.1007/s00482-014-1393-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The diagnosis of medication-overuse headache (MOH) is of central importance because this secondary headache disorder can be treated very effectively and patients do not usually respond to headache prophylaxis as long as MOH persists. The article describes important changes in the diagnostic criteria of different MOH subtypes after publication of the International Classification of Headache Disorders (ICHD-3beta) in 2013. The new classification has a crucial and direct impact on prevention and treatment of MOH. In addition interactions exist with the new criteria of chronic migraine. With a controlled medication intake scheme according to the 10-20 rule and using a medication break, MOH usually remits in most patients. If patient education and advice does not lead to remission of MOH, a specialized managed medication break or withdrawal treatment becomes necessary. This can be done on an outpatient, day clinic or inpatient basis. In uncomplicated cases, the results of these three treatment settings do not differ. From a cost-effectiveness standpoint, the outpatient treatment should be given priority. In complicated cases, a fully inpatient withdrawal treatment using a multimodal treatment concept is significantly superior.
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Affiliation(s)
- H Göbel
- Migräne- und Kopfschmerzzentrum, Neurologisch-verhaltensmedizinische Schmerzklinik Kiel, Heikendorfer Weg 9-27, 24149, Kiel, Deutschland,
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17
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18
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Diagnosis, pathophysiology and management of chronic migraine: a proposal of the Belgian Headache Society. Acta Neurol Belg 2015; 115:1-17. [PMID: 24968722 DOI: 10.1007/s13760-014-0313-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/13/2014] [Indexed: 12/24/2022]
Abstract
Chronic migraine (CM) is a disabling neurological condition affecting 0.5-2 % of the population. In the current third edition of the International Classification of Headache Disorders, medication overuse is no longer an exclusion criterion and CM is diagnosed in patients suffering from at least 15 headache days per month of which at least eight are related to migraine. CM is difficult to treat, and preventive treatment options are limited. We provide a pathogenetic model for CM, integrating the latest findings from neurophysiological and neuroimaging studies. On behalf of the Belgian Headache Society, we present a management algorithm for CM based on the international literature and adapted to the Belgian situation. Pharmacological treatment options are discussed, and recent data on transcranial and invasive neuromodulation studies in CM are reviewed. An integrated multimodal treatment programme may be beneficial to refractory patients, but at present, this approach is only supported by a limited number of observational studies and quite variable between centres.
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19
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Abstract
Medication-overuse headache (MOH) is a worldwide health problem with a prevalence of 1%–2%. It is a severe form of headache where the patients often have a long history of headache and of unsuccessful treatments. MOH is characterized by chronic headache and overuse of different headache medications. Through the years, withdrawal of the overused medication has been recognized as the treatment of choice. However, currently, there is no clear consensus regarding the optimal strategy for management of MOH. Treatment approaches are based on expert opinion rather than scientific evidence. This review focuses on aspects of epidemiology, diagnosis, pathogenesis, prevention, and treatment of MOH. We suggest that information and education about the risk of MOH is important since the condition is preventable. Most patients experience reduction of headache days and intensity after successful treatment. The first step in the treatment of MOH should be carried out in primary care and focus primarily on withdrawal, leaving prophylactic medication to those who do not manage primary detoxification. For most patients, a general practitioner can perform the follow-up after detoxification. More complicated cases should be referred to neurologists and headache clinics. Patients suffering with MOH have much to gain by an earlier treatment-focused approach, since the condition is both preventable and treatable.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Research Centre, Akershus University Hospital, Lørenskog, Norway ; Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway ; Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christofer Lundqvist
- Research Centre, Akershus University Hospital, Lørenskog, Norway ; Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway ; Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway
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20
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Barton PM, Schultz GR, Jarrell JF, Becker WJ. A Flexible Format Interdisciplinary Treatment and Rehabilitation Program for Chronic Daily Headache: Patient Clinical Features, Resource Utilization and Outcomes. Headache 2014; 54:1320-36. [PMID: 24862836 DOI: 10.1111/head.12376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Pamela M Barton
- Alberta Health Services Chronic Pain Centre, Calgary, Alberta, Canada; Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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21
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Kristoffersen ES, Lundqvist C. Medication-overuse headache: epidemiology, diagnosis and treatment. Ther Adv Drug Saf 2014; 5:87-99. [PMID: 25083264 PMCID: PMC4110872 DOI: 10.1177/2042098614522683] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Medication-overuse headache (MOH) is one of the most common chronic headache disorders and a public health problem with a worldwide prevalence of 1-2%. It is a condition characterized by chronic headache and overuse of different headache medications, and withdrawal of the overused medication is recognised as the treatment of choice. However, the strategy for achieving withdrawal is, at present, based on expert opinion rather than scientific evidence, partly due to the lack of randomised controlled studies. This narrative review investigates different aspects of epidemiology, diagnosis, risk factors and pathogenesis as well as management for MOH. We suggest that the first step in the treatment of MOH should be carried out in general practice and should focus primarily on detoxification. For most patients, both prevention and follow up after detoxification can also be performed in general practice, thus freeing resources for referral of more complicated cases to headache clinics and neurologists. These suffering patients have much to gain by an earlier treatment-focused approach lower down on the treatment ladder.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, and Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Research Centre, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway, and Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway
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22
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Abstract
This review summarizes the various forms of behavioral treatment of migraine which could demonstrate empirical efficacy. The main unimodal kinds of treatment are thermal and electromyography (EMG) biofeedback training and progressive muscle relaxation. The various relaxation techniques do not differ in their efficacy in treating migraine. On average a reduction in migraine frequency of 35-45 % is achieved. The mean effect sizes (ES) of various biofeedback techniques are between 0.4 and 0.6. Cognitive-behavioral treatment is applied as a multimodal treatment and on average achieves an improvement in migraine activity by 39 % and an ES of 0.54. All behavioral procedures can be used in combination or as an alternative to drug prophylaxis with comparable success. A combination of pharmacological and behavioral treatment can achieve additional success. There is strong evidence for the clinically significant efficacy of all forms of behavioral treatment in childhood and adolescence. There are no signs of differential indications.
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23
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Abstract
PURPOSE OF REVIEW Medication-overuse headache (MOH) is a well described clinical entity. There is a growing body of knowledge on the epidemiology of MOH, risk factors, and treatment strategies. RECENT FINDINGS The International Headache Society updated the classification criteria for MOH. Population-based studies provided an insight into the prevalence and peculiarities of MOH patients in eastern Europe and Asia. Large-scaled population-based longitudinal studies made it possible to analyze risk factors leading to the development of MOH. Imaging studies helped to better understand the pathophysiology of headache chronicity. New treatment strategies have been suggested. SUMMARY MOH is a common headache disorder and a serious public health problem all over the world. Although the treatment regimen for MOH patients is straightforward and the outcomes are favorable, it is time now to move forward and establish a predictive model for early recognition of patients at high risk, to intervene early and avoid development of chronic headache.
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Affiliation(s)
- Zaza Katsarava
- Evangelic Hospital Unna, University of Duisburg-Essen, Germany.
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25
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Soee ABL, Skov L, Skovgaard LT, Thomsen LL. Headache in children: Effectiveness of multidisciplinary treatment in a tertiary paediatric headache clinic. Cephalalgia 2013; 33:1218-28. [DOI: 10.1177/0333102413490349] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim The aim of this article is to evaluate the effectiveness of a specific multidisciplinary treatment programme for children with headache and to describe the concept and settings of the Children’s Headache Clinic in Denmark. Method All new patients were included and evaluations were conducted after six and 12 months. Pharmacological and non-pharmacological treatments were offered by a team of specialists (physicians, headache nurses, a physiotherapist and a psychologist). Patients The subjects comprised 169 children (mean age 11.7 (range 4–17), 91 females, 78 males), 39% of whom suffered from chronic headache (≥15 days/month). All children were diagnosed according to the International Classification of Headache Disorders, second edition; 20% had migraine, 34% tension-type headache, 27% mixed headache, 4% medication-overuse headache, and 15% were diagnosed with other types of headaches. Results Fifty per cent of the children had an improvement in headache frequency above 50% at six months. By the use of repeated measurement analysis, we found a significant decrease in headache frequency in all of the six headache groups, whereas the increase in quality of life (PedsQL™ 4.0) was significant for the group as a whole. Conclusion Though preliminary, the results show a good outcome for multidisciplinary treatment programmes for children who suffer from frequent or chronic headache.
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Affiliation(s)
- Ann-Britt L Soee
- Department of Paediatrics, Children’s Headache Clinic, Copenhagen University Hospital Herlev, Denmark
| | - Liselotte Skov
- Department of Paediatrics, Children’s Headache Clinic, Copenhagen University Hospital Herlev, Denmark
| | | | - Lise L Thomsen
- Department of Neuropediatrics, Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Denmark
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26
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Psychological issues in the evaluation and treatment of tension-type headache. Curr Pain Headache Rep 2013; 16:545-53. [PMID: 23054980 DOI: 10.1007/s11916-012-0301-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Tension-type headache is the most common headache disorder, affecting approximately 40 % of Americans within a one-year span. Although the most common form, episodic tension-type headache, is rarely impairing, more frequent tension-type headache can occur with significant disability and psychological comorbidity. Appreciating the psychological impact, assessing the associated biopsychosocial issues, and understanding patients' coping styles are important in forming an appropriate treatment plan and maximizing treatment outcomes. A range of psychological therapies including relaxation training, cognitive behavioral therapy, biofeedback and mindfulness have demonstrated utility in treating chronic pain conditions and reducing the associated disability. This may be particularly applicable to special populations, including pediatric patients, pregnant patients and geriatric. Psychological assessment and treatment may be done conjointly with medication management and expands treatment options. There is great need to continue researching the effects of psychological treatments, standardizing interventions and making them available to the wider population.
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28
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Diener HC, Rabe K, Gerwig M, Müller O, Sure U, Gaul C. [Neurostimulation for treatment of headaches]. DER NERVENARZT 2012; 83:994-1000. [PMID: 22801664 DOI: 10.1007/s00115-012-3571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Only a small portion of patients with primary headaches are refractory to treatment concerning relief of headache episodes and prophylactic therapy of headaches. New methods of central and peripheral neurostimulation have been developed for these patients during the last few years and experience was mostly gained in small case series. The following overview gives a description of new stimulation methods, such as deep brain stimulation, occipital nerve stimulation, vagal nerve stimulation, neurostimulation of the sphenopalatine ganglion and transcranial magnetic stimulation.
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Affiliation(s)
- H C Diener
- Universitätsklinik für Neurologie und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen, Hufelandstr. 55, 45147 Essen, Deutschland.
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Wallasch TM, Kropp P. Multidisciplinary integrated headache care: a prospective 12-month follow-up observational study. J Headache Pain 2012; 13:521-9. [PMID: 22790281 PMCID: PMC3444539 DOI: 10.1007/s10194-012-0469-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 06/21/2012] [Indexed: 11/26/2022] Open
Abstract
This prospective study investigated the effectiveness of a three-tier modularized out- and inpatient multidisciplinary integrated headache care program. N = 204 patients with frequent headaches (63 migraine, 11 tension-type headache, 59 migraine + tension-type headache, 68 medication-overuse headache and 3 with other primary headaches) were enrolled. Outcome measures at baseline, 6- and 12-month follow-ups included headache frequency, Migraine Disability Assessment (MIDAS), Hospital Anxiety and Depression Scale (HADS), standardized headache diary and a medication survey. Mean reduction in headache frequency was 5.5 ± 8.5 days/month, p < 0.001 at 6 months’ follow-up and 6.9 ± 8.3 days/month, p < 0.001 after 1 year. MIDAS decreased from 53.0 ± 60.8 to 37.0 ± 52.4 points, p < 0.001 after 6 months and 34.4 ± 53.2 points, p < 0.001 at 1 year. 44.0 % patients demonstrated at baseline an increased HAD-score for anxiety and 16.7 % of patients revealed a HAD-score indicating a depression. At the end of treatment statistically significant changes could be observed for anxiety (p < 0.001) and depression (p < 0.006). The intake frequency of attack-aborting medication decreased from 10.3 ± 7.3 days/month at admission to 4.7 ± 4.1 days/month, p < 0.001 after 6 months and reached 3.8 ± 3.5 days/month, p < 0.001 after 1 year. At baseline 37.9 % of patients had experience with non-pharmacological treatments and 87.0 % at 12-month follow-up. In conclusion, an integrated headache care program was successfully established. Positive health-related outcomes could be obtained with a multidisciplinary out- and inpatient headache treatment program.
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30
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Wallasch TM, Angeli A, Kropp P. Outcomes of a Headache-Specific Cross-Sectional Multidisciplinary Treatment Program. Headache 2012; 52:1094-105. [DOI: 10.1111/j.1526-4610.2012.02189.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:289-98. [DOI: 10.1097/spc.0b013e328353e091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Validation of criterion-based patient assignment and treatment effectiveness of a multidisciplinary modularized managed care program for headache. J Headache Pain 2012; 13:379-87. [PMID: 22581187 PMCID: PMC3381067 DOI: 10.1007/s10194-012-0453-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 04/16/2012] [Indexed: 12/02/2022] Open
Abstract
This prospective observational study evaluates the validity of an algorithm for assigning patients to a multidisciplinary modularized managed care headache treatment program. N = 545 chronic headache sufferers [migraine (53.8 %), migraine + tension type (30.1 %), tension type (8.3 %) or medication overuse headache (6.2 %), other primary headaches (1.5 %)] were assigned to one of four treatment modules differing with regard to the number and types of interventions entailed (e.g., medication, psychological intervention, physical therapy, etc.). A rather simple assignment algorithm based on headache frequency, medication use and psychiatric comorbidity was used. Patients in the different modules were compared with regard to the experienced burden of disease. 1-year follow-up outcome data are reported (N = 160). Headache frequency and analgesic consumption differed significantly among patients in the modules. Headache-related disability was highest in patients with high headache frequency with/without medication overuse or psychiatric comorbidity (modules 2/3) compared to patients with low headache frequency and medication (module 0). Physical functioning was lowest in patients with chronic headache regardless of additional problems (modules 1/2/3). Psychological functioning was lowest in patients with severe chronicity with/without additional problems (module 2/3) compared to headache suffers with no/moderate chronicity (module 0/1). Anxiety or depression was highest in patients with severe chronicity. In 1-year follow-up, headache frequency (minus 45.3 %), consumption of attack-aborting drugs (minus 71.4 %) and headache-related disability decreased (minus 35.9 %). Our results demonstrate the clinical effectiveness and the criterion validity of the treatment assignment algorithm based on headache frequency, medication use and psychiatric comorbidity.
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33
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Lauche R, Cramer H, Paul A, Dobos G, Rampp T. Introducing integrative integrated migraine care (IIMC): A model and case presentation. Eur J Integr Med 2012. [DOI: 10.1016/j.eujim.2011.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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