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Kaiser Permanente Treatment for Severe Migraine Headaches Is Effective.

Business Editors/Health/Medical Writers

PASADENA, Calif.--(BUSINESS WIRE)--Aug. 7, 2003

A unique patient care model developed at Kaiser Permanente Kaiser Permanente is an integrated managed care organization, based in Oakland, California, founded in 1945 by industrialist Henry J. Kaiser and physician Sidney R. Garfield.  for treating headache patients is highly effective and also reduces health care costs. The results are published in the June 2003 issue of Headache and describe using a group education model, combined with conventional medical therapy, to treat patients suffering from migraine and chronic daily headache disorders.

In an accompanying editorial, the journal's editor John F. Rothrock, MD, commented, "The very magnitude of the public health burden imposed by chronic headache would seem to demand identification and adoption of just such models."

"Any chronic disease relies on patient self-management for successful outcomes. Patient education is the most important element needed to improve the self-efficacy of patients managing their own disorder," said Morris Maizels, MD, of the Kaiser Permanente Woodland Hills Medical Center Department of Family Practice. "While group medical care may sound unusual, it is already widely accepted for diabetes, pregnancy education, and many psychiatric disorders."

The Kaiser Permanente Woodland Hills Headache Clinic serves a patient population of 160,000 members and is staffed by a family physician/headache specialist, two registered nurse practitioner nurse practitioner
n. Abbr. NP
A registered nurse with special training for providing primary health care, including many tasks customarily performed by a physician.


see ribonucleoprotein.
) health specialists, and a clinic coordinator. Groups of 10 to 15 patients experiencing migraine, chronic migraine or tension-type headache Tension-type headache
A dull pain that seems to exert pressure on the head; the most common form of headache.

Mentioned in: Cluster Headache
, attend education sessions led by registered nurse practitioners. After participating in the group program, they are offered an individual consultation.

In contrast to a conventional medical model based on interaction between one patient and a physician, disease management uses multidisciplinary teams to treat groups of patients. Disease management programs have been widely used for costly, life-threatening illnesses such as coronary artery disease coronary artery disease, condition that results when the coronary arteries are narrowed or occluded, most commonly by atherosclerotic deposits of fibrous and fatty tissue. , congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time.  and diabetes. However, this paper shows that conditions such as migraine can also be successfully treated with this approach.

In addition to Dr. Maizels, the paper's other authors are Valerie Saenz, RNP, of the Kaiser Permanente Woodland Hills Medical Center Department of Family Practice; and Jonathon Wirjo, project analyst, SCPMG SCPMG Southern California Permanente Medical Group  Strategic Business Initiative.

Two hundred and sixty-four patients participated in the study between April 1999 and April 2000 and reported relief of their headache pain. The greatest improvement was seen in the most severely affected patients.

Patients with primary headache Primary headache
A headache that is not caused by another disease or medical condition. Tension headaches are a subtype of primary headache.

Mentioned in: Tension Headache
 disorders, migraine, chronic migraine or tension-type headache, initially participate in an education program. Those patients whose referrals suggest cluster headache Cluster Headache Definition

Cluster headaches are characterized by an intense one-sided pain centered by the eye or temple. The pain lasts for one to two hours on average and may recur several times in a day.
, recent onset of headache or otherwise unexplained headaches are seen directly without participating in the educational program.

The education session is led by the RNP. Patients complete a detailed questionnaire and discuss their headache pain as well as talk about migraine, diagnosis, triggers, and treatment options.

After the session, patients schedule consultations with a registered nurse practitioner or a physician. Patients with more complicated diagnoses including use of narcotics narcotics n. 1) techinically, drugs which dull the senses. 2) a popular generic term for drugs which cannot be legally possessed, sold, or transported except for medicinal uses for which a physician or dentist's prescription is required.  or history of repeated treatment failures, were seen by a physician.

The project utilized triptans, a class of medications approved by the FDA FDA
Food and Drug Administration

FDA, See Food and Drug Administration.

FDA, the abbreviation for the Food and Drug Administration.
 that were discovered by researchers seeking a molecule that functions the same way as the neurotransmitter neurotransmitter, chemical that transmits information across the junction (synapse) that separates one nerve cell (neuron) from another nerve cell or a muscle. Neurotransmitters are stored in the nerve cell's bulbous end (axon).  serotonin which is thought to play a role in inflammation.

"We think that acknowledging that headache is a chronic disease is a very important development," said Dr. Maizels. "Government agencies and third-party payers are insisting on good care for conditions like heart disease and diabetes, but they have not mandated care for the treatment of the very disabling disorder of migraine. Doctors at Kaiser Permanente have sought innovative means of providing care without straining health resources which usually target the 'life-threatening' disorders."

At the same time the Woodland Hills clinic was established, the care given to headache patients in the Kaiser Permanente Woodland Hills Emergency Department was evaluated. Findings included that some patients complaining of headache pain were often not adequately diagnosed or treated. In response, patients who had come to the ER for headache treatment were contacted by letter and offered the opportunity to self-refer to the clinic. The number of headache-related clinic visits was determined by reviewing computer appointment histories and clinic charts. Headache class appointments and initial consultations were not counted as visits.

Kaiser Permanente is a prepaid, group practice health maintenance organization (HMO HMO health maintenance organization.

A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial,
), founded in 1945. The Kaiser Permanente Southern California Region has more than 3.1 million members. It includes 3,600 physicians in the Southern California Permanente Medical Group (SCPMG) and 46,000 Kaiser Foundation Health Plan and Hospitals employees. The Region is served by 11 major medical centers.
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Date:Aug 7, 2003
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