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Behavioral therapies address factors underlying migraine.

SCOTTSDALE, ARIZ. -- Misconceptions and other barriers to behavioral therapy limit headache patients' access to potentially beneficial nonpharmacologic treatments, Donald B. Penzien, Ph.D., said at a symposium sponsored by the American Headache Society.

Standard behavioral interventions include relaxation training, biofeedback training, cognitive behavioral therapy, stress management, or some combination of these approaches, said Dr. Penzien, professor of psychiatry and director of the Head Pain Center at the University of Mississippi, Jackson.

Reimbursement and workforce issues limit the use of these nonpharmacologic treatments, but another factor weighs heavily as well: the stigma of seeking care from a behavioral specialist, he said.

"The reality is that patients with migraine or tension headache don't necessarily have emotional illness, yet research shows they can still benefit from behavioral therapy," he said in an interview.

Even the best pharmacologic agents have their limits because headache is a psychophysiologic disorder, Dr. Penzien explained.

Patients most suitable for behavioral headache treatments include those with poor tolerance of and medical contraindications for drug treatment or inadequate response to medications; those who prefer non-drug interventions; pregnant and nursing women; and those with history of frequent or excessive use of analgesic or other acute medications.

"Over 300 studies have evaluated behavioral therapy for the management of migraine. On average, these interventions have shown 35%-55% improvement pretreatment to post treatment," Dr. Penzien said.

Furthermore, he added, the effects of behavioral treatments appear enduring; the literature shows efficacy up to 7 years post treatment.

Behavioral treatment typically entails 6-12 clinic sessions with a professional. Cost and time considerations have given rise to the minimal therapist contact (MTC) approach, which requires fewer sessions.

MTC interventions are started at the clinic and then patients are sent home with reading and audio materials that guide their acquisition of new behavioral skills on their own time. "Minimal contact therapies are producing results in the range of what we can do with the more intensive clinic-based therapies. The patients appreciate the convenience and lower cost," he said.

Dr. Penzien said that he would like to see primary care physicians and neurologists increase their focus on psychological and emotional factors underlying migraines. "Relatively short-term behavioral interventions can be of great importance in assisting your patients to better manage their headaches."


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Title Annotation:Pain Medicine
Author:Dixon, Bruce K.
Publication:Clinical Psychiatry News
Geographic Code:1U8AZ
Date:Jan 1, 2007
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