Complementary and integrative medicine perspectives among veteran patients and VHA healthcare providers for the treatment of headache disorders: a qualitative study

Abstract

Objective To evaluate veteran patient and provider perceptions and preferences on complementary and integrative medicine (CIM) for headache management. Background The Veterans Health Administration (VHA) has spearheaded a Whole Health system of care focusing on CIM-based care for veteran patients. Less is known about patients’ and providers’ CIM perceptions and preferences for chronic headache management. Methods We conducted semi-structured interviews with 20 veteran patients diagnosed with headache and 43 clinical providers, across 12 VHA Headache Centers of Excellence (HCoE), from January 2019 to March 2020. We conducted thematic and case comparative analyses. Results Veteran patients and VHA clinical providers viewed CIM favorably for the treatment of chronic headache. Specific barriers to CIM approaches included: (1) A lack of personnel specialized in specific CIM approaches for timely access, and (2) variation in patient perceptions and responses to CIM treatment efficacy for headache management. Conclusion Veteran patients and VHA clinical providers in this study viewed CIM favorably as a safe addition to mainstream headache treatments. Advantages to CIM include favorable adverse effect profiles and patient autonomy over the treatment. By adding more CIM providers and resources throughout the VHA, CIM modalities may be recommended more routinely in the management of veterans with headache.

Interactive CBT for headache and relaxation training (iCHART): Study protocol of a single-arm trial of interactive voice response technology delivery of cognitive-behavioral therapy for Veterans with post-traumatic headache

“…The Migraine Disability Assessment (MIDAS), 39 is a 5-item, self-report measure of life disruption due to headache in the last 1 month. Cut points represent thresholds for little or no disability (0-5), mild disability (6-10), moderate disability (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and severe disability (21þ). The Headache-related disability inventory (HDI), 40 is a 25-item self-report questionnaire that assesses both the emotional and functional impact of headache on daily activities.…”

“…Items are rated from 0 to 3 (0 ¼ not at all to 3 ¼ nearly every day) with total score ranging from 0 to 24 for the PHQ-8. The PHQ-9 provides thresholds for severity of depressive symptoms: none-minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), and severe (20)(21)(22)(23)(24)(25)(26)(27) depressive symptoms. The PHQ-8 has demonstrated exceptionally high correlation with the PHQ-9 (r ¼ 0.997) and identical cutoffs are advised.…”

“…Total scores range from 0 to 21. Cut points represent thresholds for none-minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), and severe (15)(16)(17)(18)(19)(20)(21) anxious symptoms. The GAD-7 has demonstrated high internal consistency (Cronbach a ¼ 0.92) and test-retest reliability (r ¼ 0.83), and high sensitivity (0.66-0.89) and specificity (0.80-0.81) across multiple anxiety disorders compared to structured mental health interviews.…”

“…10,11 Many individuals do not respond to medical headache treatments, experience unwanted side effects, have difficulties adhering to their prescribed medical regimen, [12][13][14] or prefer non-pharmacological treatments. 15,16 More practitioners are embracing the biopsychosocial framework as part of comprehensive, multidisciplinary, headache care. 17 Consequently, patients are increasingly encouraged to prevent and ameliorate symptomatology through pharmacologic and non-pharmacologic treatment, which is especially relevant in people with PTH given the complexities of the disease.…”

Behavioral Health, Telemedicine, and Opportunities for Improving Access

“…Access to behavioral providers with specialization in behavioral pain or headache treatments can be challenging, particularly in rural settings [ 40 ]. Therefore, patients may face limited options in behavioral treatment providers, resulting in limited behavioral treatment strategies that may not adequately address their specific treatment needs [ 41 , 42 ]. Recent studies have observed greater use of telemedicine for patients who receive specialty pain services in rural populations (12%) compared to urban patients (3%) [ 43 ].…”