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Goldman RE, Damush TM, Kuruvilla DE, Lindsey H, Baird S, Riley S, Burrone Bs L, Grinberg AS, Seng EK, Fenton BT, Sico JJ. Essential components of care in a multidisciplinary headache center: Perspectives from headache neurology specialists. Headache 2022; 62:306-318. [PMID: 35293614 DOI: 10.1111/head.14277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Comprehensive headache care involves numerous specialties and components that have not been well documented or standardized. This study aimed to elicit best practices and characterize important elements of care to be provided in multidisciplinary headache centers. METHODS Qualitative, semi-structured telephone interviews with a purposive sample of headache neurology specialists from across the US, using open-ended questions. Interviews were recorded, transcribed, and coded. Coded data were further analyzed using immersion/crystallization techniques for final interpretation. RESULTS Mean years providing headache care was 17.7 (SD = 10.6). Twelve of the 13 participants held United Council for Neurologic Subspecialties headache certification. Six described their practice site as providing multidisciplinary headache care. Participants explained most of their patients had seen multiple doctors over many years, and had tried numerous unsuccessful treatments. They noted patients with chronic headache frequently present with comorbidities and become stigmatized. All participants asserted successful care depends on taking time to talk with and listen to patients, gain understanding, and earn trust. All participants believed multidisciplinary care is essential within a comprehensive headache center, along with staffing enough headache specialists, implementing detailed headache intake and follow-up protocols, and providing the newest medications, neuromodulation devices, botulinum toxin injections, monoclonal antibodies, nerve blocks and infusions, and treatment from a health psychologist. Other essential services for a headache center are other behavioral health practitioners providing cognitive behavioral therapy, mindfulness, biofeedback and pain management; and autonomic neurology, neuropsychology, vestibular audiology, sleep medicine, physical therapy, occupational therapy, exercise physiology, speech therapy, nutrition, complementary integrative health modalities, and highly trained support staff. CONCLUSION While headache neurology specialists form the backbone of headache care, experts interviewed for this study maintained their specialty is just one of many types of care needed to adequately treat patients with chronic headache, and this is best provided in a comprehensive, multidisciplinary center.
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Affiliation(s)
- Roberta E Goldman
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA
| | - Teresa M Damush
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Deena E Kuruvilla
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Westport Headache Institute, Westport, Connecticut, USA
| | - Hayley Lindsey
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Sean Baird
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Samantha Riley
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Laura Burrone Bs
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA
| | - Amy S Grinberg
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA
| | - Elizabeth K Seng
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Brenda T Fenton
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason J Sico
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
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3
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Matsuzawa Y, Lee YSC, Fraser F, Langenbahn D, Shallcross A, Powers S, Lipton R, Simon N, Minen M. Barriers to Behavioral Treatment Adherence for Headache: An Examination of Attitudes, Beliefs, and Psychiatric Factors. Headache 2019; 59:19-31. [PMID: 30367821 PMCID: PMC6344047 DOI: 10.1111/head.13429] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Nonpharmacological interventions, such as biofeedback, cognitive behavioral therapy, and relaxation techniques are Level-A evidence-based treatments for headache. The impact of these interventions is often equivalent to or greater than pharmacological interventions, with fewer side effects. Despite such evidence, the rate of participation in nonpharmacological interventions for headache remains low. Once obstacles to optimizing use of behavioral interventions, such as local access to nonpharmacological treatment and primary headache providers are traversed, identification of barriers contributing to low adherence is imperative given the high levels of disability and cost associated with treating headache disorders. In this review of factors in adults associated with underuse of nonpharmacological interventions, we discuss psychological factors relevant to participation in nonpharmacological treatment, including attitudes and beliefs, motivation for change, awareness of triggers, locus of control, self-efficacy, acceptance, coping styles, personality traits, and psychiatric comorbidities associated with treatment adherence. Finally, future prospects and approaches to optimizing treatment matching and minimizing adherence issues are addressed. METHODS An interdisciplinary team conducted this narrative review. Neuropsychologists conducted a literature search during the month of July 2017 using a combination of the keywords ("headache" or "migraine") and ("adherence" or "compliance") or "barriers to treatment" or various "psychological factors" discussed in this narrative review. Content experts, a psychiatrist, and a complementary and integrative health specialist provided additional commentary and input to this narrative review resulting in integration of additional noteworthy studies, book chapters and books. RESULTS Various psychological factors, such as attitudes and beliefs, lack of motivation, poor awareness of triggers, external locus of control, poor self-efficacy, low levels of acceptance, and engagement in maladaptive coping styles can contribute to nonadherence. CONCLUSIONS To maximize adherence, clinicians can assess and address an individual's level of treatment acceptance, beliefs that may present as barriers, readiness for change, locus of control, self-efficacy and psychiatric comorbidities. Identification of barriers to adherence as well as the application of relevant assessment and intervention techniques have the potential to facilitate adherence and ultimately improve treatment success.
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Affiliation(s)
- Yuka Matsuzawa
- Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA
| | | | - Felicia Fraser
- Department of Physical Medicine & Rehabilitation, the MetroHealth System, Cleveland, OH, USA
| | - Donna Langenbahn
- Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA
| | - Amanda Shallcross
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Scott Powers
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Richard Lipton
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - Naomi Simon
- Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Mia Minen
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
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Tavallaei V, Rezapour-Mirsaleh Y, Rezaiemaram P, Saadat SH. Mindfulness for female outpatients with chronic primary headaches: an internet-based bibliotherapy. Eur J Transl Myol 2018; 28:7380. [PMID: 29991985 PMCID: PMC6036307 DOI: 10.4081/ejtm.2018.7380] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 03/29/2018] [Indexed: 01/03/2023] Open
Abstract
Our aim was to investigate effectiveness of mindfulness by bibliotherapy on disability, distress, perceived pain and mindfulness in women with tension headaches and migraines. Primary headaches have been of great interest to mental health researchers because of the high prevalence, as well as significant disability and distress in the affected people. Despite the promising results of in-person treatment and some limitations that such interventions may cause, patients may be encountered with problems when using health care services. The present study is a quasi-experimental randomized design with pre-test, post-test, and control group. The study population consisted of 1396 women with migraine headache referring to headache clinic of Baqiyatallah Hospital in Tehran. Of these, 30 patients (including tboh experimental and control group) were selected by objective sampling method and were randomly assigned to the two groups. The experimental group, in addition to medical treatment as usual, was treated for a period of 8 sessions by Mindfulness-based Stress Reduction Internet-based Bibliotherapy, but the control group used only the medical treatment. The sample had no attritions. Data were collected by the four scales of (DASS-21), Migraine Disability Assessment Test (MIDAS), McGill's Short Form Questionnaire (MPQ-SF), and Mindfulness Inventory (MAAS). We used covariance analysis to analyze the findings in the measured scales. MBSR-IBB treatment had no significant effect on pain sensory dimension (P <0.44), despite improvement of mindfulness (P <0.0001). In contrast, the greatest effect was on the level of disability (P <0.0001). We observed also a significant improvement in distress (P <0.0001). In conclusion, in spite of the presence of headaches, the mindfulness improved the quality of life and reduced the level of mental distress. In addition, using the Internet-based bibliotherapy method, these services can be used with easier access, lower cost, and more flexibility.
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Affiliation(s)
- Vahid Tavallaei
- Counseling Department, Education & Psychology Faculty, Ardakan University, Ardakan, Iran
| | | | - Peyman Rezaiemaram
- Psychology Department, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Seyed Hassan Saadat
- Behavioral Science Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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5
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Faizi F, Tavallaee A, Rahimi A, Saghafinia M. Psychiatric Comorbidities and Environmental Triggers in Patients with Chronic Daily Headache: A Lifestyle Study. IRANIAN JOURNAL OF PSYCHIATRY 2017; 12:29-35. [PMID: 28496499 PMCID: PMC5425349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
Objective: Patients with chronic daily headache (CDH) suffer from several significant psychiatric comorbidities and have unhealthy lifestyle. We aimed at studying psychiatric comorbidities, environmental triggers, lifestyle factors, and intensity of CDH in patients referred by the department of neurology from 2011 to 2014. Method: Through medical and psychiatric interviews and using 0 to 10 visual analogue scale (VAS), we assessed patients with CDH, using a checklist, to elicit psychiatric comorbidities, intensity of CDH, environmental factors, and lifestyle derangement. Results: We interviewed 413 (age 16-80 years, mean 40 +/- 14.0) out of 548 patients; 312 (75.5%) were married, and 282 (68.1%) were female. Environmental triggers (374, 90.6%) were the most common cause of CDH, while 214 (51.8%) had no compliance to recommended nutrition. Exercise avoidance (201, 48.7%) was the less prevalent lifestyle factor. Of the patients, 372 (90.1%) were stressed and 162 (39.2%) had obsessive-compulsive disorder (OCD), which were the most and less prevalent psychiatric comorbidities, respectively. Intensity of pain was moderate to severe (mean score = 7.1+/- 1.9), while females reported higher VAS scores (p<0.02). Patients with previous history of psychotherapy reported higher score of VAS (p<0.001). Those patients living with a person suffering from head pain reported more VAS score (p<0.003). Conclusion: Notable psychiatric comorbidities were found in patients with CDH, many of which are modifiable such as environmental triggers and unhealthy lifestyle. In heavily populated cities, these factors may double the burden of the CDH by precipitating new or exacerbating previous psychiatric comorbidities. We, thus, suggest conducting more studies on this subject.
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Affiliation(s)
- Fakhrudin Faizi
- PhD Candidate in Pain Research and Management, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Tavallaee
- Associated Professor of Psychiatry, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Corresponding Author: Tel: 021 88053768, Fax: 021 88063957,
| | - Aboulfazl Rahimi
- PhD, Assistant Professor, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Masoud Saghafinia
- Associated Professor, Pain Fellowship at Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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