1
|
Persson M, Rembeck G, Weineland S. Conceptualising migraine attacks from a biopsychosocial model using qualitative and functional behavioural analysis. Scand J Prim Health Care 2023; 41:257-266. [PMID: 37409784 PMCID: PMC10478623 DOI: 10.1080/02813432.2023.2231034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/25/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore patients' experiences and management of pain in connection with a migraine attack in episodic migraine. DESIGN, SETTING AND SUBJECTS This qualitative study used a semi-structured interview format based on functional behavioural analysis as commonly used in cognitive behavioural therapy. We interviewed eight participants and analysed their responses using systematic text condensation. RESULTS Participants' descriptions of their experiences and management of pain from episodic migraine were sorted into three description First physical sensations, Automatic reactions and Acts according to the interpretation. CONCLUSION From a biopsychosocial perspective, a migraine attack is much more complex than just an experience of pain. The purely biological pain prompts a number of automatic reactions leading to strategies for pain management.
Collapse
Affiliation(s)
- Marie Persson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Care, Research, Region Västra Götaland, Sweden
- Närhälsan, Region Västra Götaland, Sweden
| | - Gun Rembeck
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Care, Research, Region Västra Götaland, Sweden
- Regional Health, Borås Youth Guidance Centre, Region Västra Götaland, Sweden
| | - Sandra Weineland
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Care, Research, Region Västra Götaland, Sweden
- Närhälsan, Region Västra Götaland, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
2
|
Perceptions, experiences, and understandings of cluster headache among GPs and neurologists: a qualitative study. Br J Gen Pract 2020; 70:e514-e522. [PMID: 32482627 DOI: 10.3399/bjgp20x710417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/30/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cluster headache is a severe primary headache with a similar prevalence to that of multiple sclerosis. Cluster headache is characterised by unilateral trigeminal distribution of pain, ipsilateral cranial autonomic features, and a tendency to circadian and circannual periodicity. AIM To explore the perceptions, experiences, and understandings of cluster headache among GPs and neurologists. DESIGN AND SETTING Qualitative interview study in primary care surgeries and neurology departments in the north of England. METHOD Semi-structured interviews were conducted with GPs and neurologists, recorded, and transcribed. A thematic analysis was applied to the dataset. RESULTS Sixteen clinicians participated in this study: eight GPs and eight neurologists. Four main themes were identified following thematic analysis: challenges with the cluster headache diagnosis; impact of cluster headache; challenges with treatment; and appropriateness of referrals to secondary care. Clinicians recognised the delays in the diagnosis of cluster headache, misdiagnosis, and mismanagement, and were aware of the potential impact cluster headache can have on patients' mental health and ability to remain in employment. Findings highlighted tensions between primary and secondary care around the cost of medication and the remit of prescribing treatment regimens. Patients' anxiety, their need for reassurance, and their insistence about seeing a specialist are some of the reasons for referrals. CONCLUSION Clinicians acknowledged delays in diagnosis, misdiagnosis, and mismanagement of cluster headache. The responsibility of prescribing causes ongoing tensions between primary and secondary care. Clear referral and management pathways for primary headaches are required to improve patient outcomes and healthcare costs.
Collapse
|
3
|
Shabani M, Najat H, Saffarian MR. Comparison of the Effectiveness of Mindfulness-Based Cognitive Therapy and a Quality of Life-Based Therapy on Rumination in Patients With Migraine. INTERNATIONAL JOURNAL OF BASIC SCIENCE IN MEDICINE 2019. [DOI: 10.15171/ijbsm.2019.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: The effects of mindfulness-based cognitive therapy and quality of life-based therapy on rumination were compared in patient with migraine. The present study also investigated the effectiveness of quality of life-based therapy and mindfulness-based cognitive therapy.Methods: This quasi-experimental study with 3 (2 experimental and one control) groups was carried out with pretest-post test design. The study population consisted of all patients with migraine headache referring to Torbat Heidarie hospitals and clinics from June to July 2018. The samples were 45 patients who were selected by random sampling and then randomly allocated to 2 experimental groups and one control group each with 15 members. One experimental group underwent mindfulness-based cognitive therapy and the other received quality of life based therapy. The control group received no intervention. Research instruments were Ahvaz Migraine Questionnaire and Huksema and Maro’s Ruminative Response Scale. The tools were filled out by the participants before and after the interventions. The data was analyzed in SPSS version 22.Results: The mindfulness-based cognitive therapy and quality of life-based therapy significantly improved rumination in patients with migraine. In addition, the effectiveness of the 2 interventions was not significantly different.Conclusion: The educational interventions based on modifying basic cognitions, replacing negative intrusive thoughts with positive thoughts, and avoiding and neutralizing intrusive thoughts through mindfulness-based cognitive methods and interventions based on improving quality of life resulted in a substantial improvement of rumination and frequent intrusive thoughts. Indeed, changes in cognitive reactions to pain and altering beliefs and expectations are the main mechanisms for improving headache.
Collapse
Affiliation(s)
- Mohammad Shabani
- Department of Education Sciences, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Hamid Najat
- Department of Psychology, Guchan Branch, Islamic Azad University, Guchan, Iran
| | | |
Collapse
|
4
|
Fattahzadeh-Ardalani G, Aghazadeh V, Atalu A, Abbasi V. Somatoform Dissociation, Fatigue Severity and Pain Behavior Compared in Patients with Migraine Headache and in Healthy Individuals. Neurol Int 2017; 9:7015. [PMID: 28713529 PMCID: PMC5505118 DOI: 10.4081/ni.2017.7015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/14/2017] [Accepted: 04/22/2017] [Indexed: 11/23/2022] Open
Abstract
The prevalence of migraine in the world is about 15 and 7% among women and men, respectively. The purpose of this study was comparison of somatoform dissociation, fatigue severity and pain behavior in patients with migraine headache and its relationship with coping strategies. This descriptive analytical study has been done on 120 patients with migraine headache and 120 healthy subjects were selected randomly. Data collected by somatoform dissociation questionnaire (SDQ-20), fatigue severity scale, pain behavior scale and coping strategies scale. For data analysis we used SPSS.19. The means of the somatoform dissociation, pain behavior scale, help searching subscale and pain compliant in migraine and healthy subjects were statistically significant. There was not significant difference in avoidance subscales between the two groups. Comparison of fatigue severity in patients with migraine and control group was meaningful. There was significant positive correlation between all four scales and coping strategies. It seems that these symptoms can play an important role in this disease; thus, their careful evaluation in the treatment of migraine headache is essential.
Collapse
Affiliation(s)
| | - Vida Aghazadeh
- Young Researchers Club and Elite Club, Ardabil Branch, Islamic Azad University, Ardabil, Iran
| | - Abolfazl Atalu
- Department of Neurology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Vahid Abbasi
- Department of Neurology, Ardabil University of Medical Sciences, Ardabil, Iran
| |
Collapse
|
5
|
Toldo I, Rattin M, Perissinotto E, De Carlo D, Bolzonella B, Nosadini M, Rossi LN, Vecchio A, Simonati A, Carotenuto M, Scalas C, Sciruicchio V, Raieli V, Mazzotta G, Tozzi E, Valeriani M, Cianchetti C, Balottin U, Guidetti V, Sartori S, Battistella PA. Survey on treatments for primary headaches in 13 specialized juvenile Headache Centers: The first multicenter Italian study. Eur J Paediatr Neurol 2017; 21:507-521. [PMID: 28082014 DOI: 10.1016/j.ejpn.2016.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 12/06/2016] [Accepted: 12/21/2016] [Indexed: 01/03/2023]
Abstract
AIM The purpose of this retrospective multicenter study was to evaluate the use and the self-perceived efficacy and tolerability of pharmacological and non-pharmacological treatments in children and adolescents with primary headaches. METHODS Study of a cohort of children and adolescents diagnosed with primary headache, consecutively referred to 13 juvenile Italian Headache Centers. An ad hoc questionnaire was used for clinical data collection. RESULTS Among 706 patients with primary headaches included in the study, 637 cases with a single type of headache (migraine 76% - with and without aura in 10% and 67% respectively; tension-type headache 24%) were selected (mean age at clinical interview: 12 years). Acetaminophen and non-steroidal anti-inflammatory drugs (in particular ibuprofen) were commonly used to treat attacks, by 76% and 46% of cases respectively. Triptans were used overall by 6% of migraineurs and by 13% of adolescents with migraine, with better efficacy than acetaminophen and non-steroidal anti-inflammatory drugs. Preventive drugs were used by 19% of migraineurs and by 3% of subjects with tension-type headache. In migraineurs, flunarizine was the most frequently used drug (18%), followed by antiepileptic drugs (7%) and pizotifen (6%), while cyproheptadine, propanolol and amitriptyline were rarely used. Pizotifen showed the best perceived efficacy and tolerability. Melatonin and nutraceuticals were used by 10% and 32% of subjects, respectively, both for migraine and tension-type headache, with good results in terms of perceived efficacy and tolerability. Non-pharmacological preventive treatments (i.e. relaxation techniques, biofeedback, cognitive-behavioral therapy, acupuncture) were used only by 10% of cases (migraine 9%, tension-type headache 15%). DISCUSSION Non-steroidal anti-inflammatory drugs, especially ibuprofen, should be preferred to acetaminophen for acute attacks of migraine or tension-type headache, because they were usually more effective and well tolerated. Triptans could be used more frequently as first or almost second choice for treating migraine attack in adolescents. Non-pharmacological preventive treatments are recommended by some pediatric guidelines as first-line interventions for primary headaches and their use should be implemented in clinical practice. Prospective multicenter studies based on larger series are warranted to better understand the best treatment strategies for young people with primary headaches.
Collapse
Affiliation(s)
- Irene Toldo
- Juvenile Headache Centre, University Hospital of Padua, Italy.
| | - Martina Rattin
- Juvenile Headache Centre, University Hospital of Padua, Italy.
| | - Egle Perissinotto
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.
| | - Debora De Carlo
- Juvenile Headache Centre, University Hospital of Padua, Italy.
| | | | | | | | - Angelo Vecchio
- Child Neuropsychiatry Division, University of Palermo, Italy.
| | | | | | - Cinzia Scalas
- Juvenile Headache Centre, University Hospital of Florence, Italy.
| | | | - Vincenzo Raieli
- Child Neuropsychiatry Division, "G.F. Ingrassia" Hospital, AUSL n°6, Palermo, Italy.
| | - Giovanni Mazzotta
- Child and Juvenile Neuropsychiatry Unit, ASL n°4, Terni, University of Perugia, Italy.
| | - Elisabetta Tozzi
- Department of Experimental Medicine, University of L'Aquila, Italy.
| | | | - Carlo Cianchetti
- Child and Adolescent Neuropsychiatry, University Hospital of Cagliari, Italy.
| | - Umberto Balottin
- Child Neuropsychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy.
| | - Vincenzo Guidetti
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, University "La Sapienza" of Rome, Italy.
| | - Stefano Sartori
- Juvenile Headache Centre, University Hospital of Padua, Italy.
| | | |
Collapse
|