Download General - Headache Cooperative of New England

Behavioral Approaches to
Headache Management
Steven M. Baskin Ph.D
New England Institute for
Behavioral Medicine
Stamford, Connecticut
Psychobiological Model
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The organic/psychogenic distinction is
not useful
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Conditions that control chronic
headache are multidimensional
involving cognitive/emotional/
behavioral factors as well as biological
processes
General Treatment Principles I
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The history is the heart of diagnosis and
treatment
A patient’s goals are individual
The Headache Diary helps doctor to see
patterns/ assess outcome
Things that need to be stopped:
– headache inducing medications
– ineffective or unnecessary medications
(including vitamins, herbs)
– overuse of immediate relief medications
General Treatment Principles II
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Avoid / limit headache triggers
Lifestyle management
Evaluate other relevant medical conditions
Optimize treatment of acute attacks
Assess the need for preventive therapy
Reassessment of the plan as needed
Headache History
Grade the headache by its intensity/severity
Incapacitating
(operational
definition)
Moderate - severe
Dull
note characteristics of pain for each intensity headache
frequency
prodrome/aura
location/laterality
associated symptoms
character of pain
behavior during attack
medication usage and relief
time of onset/duration/ pain patterns
“If I don’t take the
pills, all my
headaches will be
incapacitating.”
Rebound Headache
“The worsening of head pain in
chronic headache sufferers, caused
by the frequent and excessive use
of immediate relief medications.”
To maximize Adherence
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Accurately identify migraine onset
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Keep medication readily available
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Clear written instructions as to dosage
repeating dosage and limits for abortive
agents
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Specific titration schedules for
preventives and strategies for side effect
management
Prodromal Phenomena
Psychologic
Neurologic
General
– hypo or
– light/sound
– neck tightness
hyperactivity
– mood changes
up or down
– irritability
– restlessness
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sensitivity
cognitive
changes
“off-balance”
language
dysfunction
yawning
hyperosmia
– food cravings
– cold feelings
– decreased
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appetite
fatigue
GI changes
frequent
urination
thirst
fluid retention
Behavioral Medicine Program
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Time-limited and goal oriented
Active participation and personal responsibility
Education
Self-monitoring with headache diary
Dietary and behavior changes
Relaxation / biofeedback to foster self-regulation
Cognitive strategies to enhance coping
Maximize adherence to drug regimens
Diagnose and treat coexisting psychiatric
problems both pharmacologically and
psychologically
General Hints for Headache
Control
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• Maintain consistent biological rhythms
• Sleep/wake patterns consistent
including weekends
• Avoid oversleeping
• Same bedtime/ time of awakening
• Eat nutritious meals at regular intervals
• Increase aerobic exercise
Stress Management Training
Acute Migraine
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Preparing for a migraine
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The beginning of the headache
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As intensity builds
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Coping with thoughts and feelings at critical
moments
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Self-reflection and evaluation