Challenges of nonpharmacologic interventions in chronic tension-type headache

Smitherman, Todd A.; Penzien, Donald; Rains, Jeanetta

doi:10.1007/s11916-007-0236-y

Cited by 16 publications

(10 citation statements)

References 45 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Being able to implement clinically effective behavioral interventions outside of the research context and finding the best ways to standardize dissemination to practitioners is a burgeoning area of research that needs to be further addressed in the field of headache 16,42‐45. A number of barriers can prevent patients from accessing and using evidence‐based behavioral and mind/body treatments for headache . As previously described, these interventions often require a significant commitment of time, energy, and in some cases financial resources, from patients.…”

Section: Key Unanswered Research Questionsmentioning

confidence: 99%

“…There are many inherent difficulties in researching behavioral and mind/body practices . Double‐blinded placebo‐controlled randomized clinical trials (RCTs) are the gold standard for assessing clinical efficacy of an intervention, but double‐blinded trials are impossible in most non‐pharmacological interventions, and attempts at “psychological placebo controls” have been fraught with logistical and interpretive challenges .…”

Section: Key Unanswered Research Questionsmentioning

confidence: 99%

See 1 more Smart Citation

Behavioral and Mind/Body Interventions in Headache: Unanswered Questions and Future Research Directions

et al. 2014

Self Cite

View full text Add to dashboard Cite

Background.-Many unanswered questions remain regarding behavioral and mind/body interventions in the treatment of primary headache disorders in adults.Methods.-We reviewed the literature to ascertain the most pressing unanswered research questions regarding behavioral and mind/body interventions for headache.Results.-We identify the most pressing unanswered research questions in this field, describe ideal and practical ways to address these questions, and outline steps needed to facilitate these research efforts. We discuss proposed mechanisms of action of behavioral and mind/body interventions and outline goals for future research in this field.Conclusions.-Although challenges arise from the complex nature of the interventions under study, research that adheres to published study design and reporting standards and focuses closely on answering key questions is most likely to lead to progress in achieving these goals. Key words: alternative medicine, headache, mind/body Abbreviations: CAM complementary and alternative medicine, TTH tension-type headacheNon-pharmacological interventions have long been perceived by patients and providers as beneficial for headaches, and strong evidence supports the useful effects of certain nonpharmacological interventions for migraine and tension-type headache (TTH). The US Headache Consortium Guidelines for prevention of migraine identified Grade A evidence to support several specific non-pharmacological interventions including relaxation training, thermal biofeedback combined with relaxation training, electromyographic (EMG) biofeedback, and cognitive behavioral therapy (CBT) 1 (labeled as "evidence-based behavioral interventions" for this paper). The combination of preventive drug therapy and evidence-based behavioral therapies was identified as having Grade B evidence for producing added clinical benefit, although data published since these guidelines were issued is likely to change the evidence to Grade A when the guidelines are updated. 2,3 In addition to evidence-based behavioral interventions, a recent study found that more than 50% of US adults with migraines/severe headaches reported having used complementary and alternative medicine (CAM) techniques, most commonly "mind/body therapies" such as meditation and yoga. 4 Thus, although data most strongly support evidence-based behavioral interventions, it seems that mind/body interventions are used frequently by adults with primary headache disorders. Despite their use, many unanswered questions remain regarding these non-pharmacological interventions in the treatment of primary headache disorders in adults. In 2005, Headache published an entire series of peer-reviewed papers (many cited in this review) that provided in-depth analysis of numerous methodological issues and suggested solutions in behavioral headache research. Given the increased utilization of mind/body therapies and potentially similar underlying mechanisms between evidencebased behavioral interventions and mind/body therapies, the goal of this paper is to id...

show abstract

Section: Key Unanswered Research Questionsmentioning

confidence: 99%

Section: Key Unanswered Research Questionsmentioning

confidence: 99%

Behavioral and Mind/Body Interventions in Headache: Unanswered Questions and Future Research Directions

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

“…Rather than jaw joint problems per se causing tension headache and migraine, it may be that they share a similar underlying central nervous system pathophysiology (Bevilaqua Grossi et al, 2009). The teaching of relaxation skills and coping strategies as well as being effective in TMD (Sherman and Turk, 2001;Suvinen et al, 2005) is also beneficial in migraine (Campbell et al, 2009) and tension headache (Smitherman et al, 2007).…”

Section: Migraine Tension Headache and Tmdmentioning

confidence: 99%

Breathing and temporomandibular joint disease

Bartley

2011

Journal of Bodywork and Movement Therapies

View full text Add to dashboard Cite

“…Their effect on factors facilitating chronic pain is well known [63], though a more realistic approach will likely combine pharmacological, physical, and psychological components tailored to each patient's needs [64]. The use of non-pharmacological approach to tension-type headache treatment, should be supported by rigorous studies designs, evaluating the outcome of patients features, including pericranial tenderness, anxiety and depression, sleep disturbances and quality of life [65] The challenge for future therapeutic approaches to migraine and tension-type headache should be a global prevention of chronic pain, through a good control of factors subtending and facilitating central sensitisation, with a final end-point of better quality of life. Fig.…”

Section: Preventive Therapies For Mi-graine and Tension Type Headachementioning

confidence: 99%

Central Sensitisation Phenomena in Primary Headaches: Overview of a Preventive Therapeutic Approach

Tommaso

Sardaro²,

Vecchio³

et al. 2008

CNSNDDT

View full text Add to dashboard Cite

Central sensitisation phenomena have been well recognized in the development of migraine attacks and tension type headache. It is also known that headache frequency is related to sensitization. Though some studies have focused on the effects of symptomatic treatment on allodynia, few reports have described the action of preventive agents on the facilitating factors for central sensitisation. In this study we aim to review the factors concurrent with an increase in central sensitisation, in view of the choice of preventive agents for primary headaches. Central sensitisation phenomena are increased in pain syndromes with psycho-pathological co-morbidities. For instance, sleep disorders are a frequent symptom in headache, prevailing in chronic forms and in patients with psychiatric comorbidity. Sleep deprivation is also a factor producing hyperalgesic changes. It is known that symptoms attributable to central sensitization are diffusely pronounced in fibromyalgic (FMS) patients, and that FMS co-morbidity is frequent in primary headaches and associated with higher frequency and poorer quality of life. We report our preliminary experience in a group of 20 chronic migraine patients, treated with duloxetine 60 mg/die vs a self-management program including stretching (relaxation training) and exercise (cervical-dorsal flexion and rotation) to decrease strength and flexibility of muscles of cervical and dorsal spine headache patients. Both the treatments were effective on headache frequency and pericranial tenderness, although FMS comorbidity significantly reduced their efficacy on migraine and quality of life. The whole spectrum of action of pharmacological and non pharmacological treatments on central sensitisation mechanisms, and on their facilitating factors, should be taken into account for the best preventive therapeutic approach of primary headaches.

show abstract

Challenges of nonpharmacologic interventions in chronic tension-type headache

Cited by 16 publications

References 45 publications

Behavioral and Mind/Body Interventions in Headache: Unanswered Questions and Future Research Directions

Behavioral and Mind/Body Interventions in Headache: Unanswered Questions and Future Research Directions

Breathing and temporomandibular joint disease

Central Sensitisation Phenomena in Primary Headaches: Overview of a Preventive Therapeutic Approach

Contact Info

Product

Resources

About