Reduction In Headache Activity Research Articles

Perimenstrual Eletripan Prevents Menstrual Migraine: An Open‐Label Study

To prospectively evaluate the efficacy of perimenstrual prophylaxis with eletriptan to reduce headaches in women identified with menstrual migraine (MM). Female migraineurs self-reporting a substantial relationship between migraine and menses were evaluated with 3 consecutive months of daily headache recording diaries. A relationship between menses and migraine was evaluated using International Classification of Headache Disorders (ICHD-II) criteria and a probability model called Probability MM. Women prospectively diagnosed with ICHD-II MM were treated for 3 consecutive months with perimenstrual eletriptan 20 mg 3 times daily starting 2 days prior to the expected onset of menstruation and continued for a total of 6 days. Headache activity was compared during the 3 months of recording prior to eletriptan therapy and 3 months with eletriptan perimenstrual prevention therapy. Three months of pretreatment prospective diaries were completed by 126 women. ICHD-II menstrually related migraine was diagnosed in 74%, with pure MM in 7%. Among those women diagnosed with ICHD-II MM, 61 completed at least 1 treatment month. Overall change in headache activity was a 46% decrease. The mean percentage of treated menses without migraine occurring during the 6 days of treatment was 71%. The percentage of subjects with 1, 2, and 3 migraine-free menstrual periods (no migraines occurring 2 days before menses through the first 3 days of menstruation) with eletriptan, respectively, were 14%, 19%, and 53%. Among those subjects who remained headache-free during the 6 days of eletriptan treatment, migraine occurred during the 3 days immediately after discontinuing eletriptan for 9%. Perimenstrual eletriptan was generally tolerated and no abnormalities were identified on the 6(th) day of treatment using either blood pressure recording or electrocardiogram. Among patients with prospectively identified MM, eletriptan 20 mg 3 times daily effectively reduced MM. A significant reduction in headache activity occurred for 53% of patients.

Change Mechanisms in EMG Biofeedback Training: Cognitive Changes Underlying Improvements in Tension Headache

Forty-three college students suffering from recurrent tension headache were randomly assigned to 1 of 4 electromyographic (EMG) biofeedback training conditions. Although all subjects were led to believe they were learning to decrease frontal EMG activity, actual feedback was contingent on decreased EMG activity for half of the subjects and increased EMG activity for the other half. Within these 2 groups, subjects also viewed bogus video displays designed to convince them they were achieving large (high success) or small (moderate success) reductions in EMG activity. Regardless of actual changes in EMG activity, subjects receiving high-success feedback showed substantially greater improvement in headache activity (53%) than subjects receiving moderate success feedback (26%). Performance feedback was also related to changes in locus of control and self-efficacy. Changes in these 2 cognitive variables during biofeedback training were also correlated with reductions in headache activity following treatment, whereas changes in EMG activity exhibited during training were uncorrelated with outcome. These results suggest that the effectiveness of EMG biofeedback training with tension headache may be mediated by cognitive changes induced by performance feedback and not primarily by reductions in EMG activity.

The Effect of the Definition of Menstrually-Related Headache on the Response to Biofeedback Treatment

Twelve women with either pure migraine headache (HA) or a combination of migraine and tension-type HA monitored HA activity over two menstrual cycles while noting onset of menstruation and onset of ovulation. They then received 12 sessions of thermal biofeedback (TBF) with adjunctive autogenic training. Six women with only tension-type HA participated in similar monitoring before receiving 9 sessions of progressive relaxation training. Results for those with vascular HA showed a significant reduction in HA activity and a reduction in medication taken for HAs. Those with tension-type HA did not respond significantly to the relaxation training. Depending upon how one defined menstrually-related HAs among those with vascular HA, there either was, or was not, a differential effect of TBF on menstrual-cycle-related HA.

Management of Chronic Tension-Type Headache With Tricyclic Antidepressant Medication, Stress Management Therapy, and Their Combination

Chronic tension-type headaches are characterized by near-daily headaches and often are difficult to manage in primary practice. Behavioral and pharmacological therapies each appear modestly effective, but data are lacking on their separate and combined effects. To evaluate the clinical efficacy of behavioral and pharmacological therapies, singly and combined, for chronic tension-type headaches. Randomized placebo-controlled trial conducted from August 1995 to January 1998 at 2 outpatient sites in Ohio. Two hundred three adults (mean age, 37 years; 76% women) with diagnosis of chronic tension-type headaches (mean, 26 headache d/mo). Participants were randomly assigned to receive tricyclic antidepressant (amitriptyline hydrochloride, up to 100 mg/d, or nortriptyline hydrochloride, up to 75 mg/d) medication (n = 53), placebo (n = 48), stress management (eg, relaxation, cognitive coping) therapy (3 sessions and 2 telephone contacts) plus placebo (n = 49), or stress management therapy plus antidepressant medication (n = 53). Monthly headache index scores calculated as the mean of pain ratings (0-10 scale) recorded by participants in a daily diary 4 times per day; number of days per month with at least moderate pain (pain rating >/=5), analgesic medication use, and Headache Disability Inventory scores, compared by intervention group. Tricyclic antidepressant medication and stress management therapy each produced larger reductions in headache activity, analgesic medication use, and headache-related disability than placebo, but antidepressant medication yielded more rapid improvements in headache activity. Combined therapy was more likely to produce clinically significant (>/=50%) reductions in headache index scores (64% of participants) than antidepressant medication (38% of participants; P =.006), stress management therapy (35%; P =.003), or placebo (29%; P =.001). On other measures the combined therapy and its 2 component therapies produced similar outcomes. Our results indicate that antidepressant medication and stress management therapy are each modestly effective in treating chronic tension-type headaches. Combined therapy may improve outcome relative to monotherapy.

Role of parent-mediated pain behavior management strategies in biofeedback treatment of childhood migraines

This study explored the use of parent-mediated pain behavior management strategies as an adjunct to the biofeedback treatment of children with migraine headaches. Twenty-seven children, ages 7 to 18, presenting with migraine headaches were randomly assigned to either a biofeedback treatment group or a biofeedback treatment group that included pain behavior management guidelines for parents. Both groups demonstrated significant reductions in headache activity. The group receiving parent-mediated pain management guidelines, however, evidenced significantly greater reductions in headache frequency, were more likely to experience clinically significant improvements, and were more likely to be headache-free. In addition, the group that received parent-mediated pain management guidelines reported children who demonstrated better adaptive functioning during treatment and at 3-month follow-up. The addition of parent-mediated pain behavior management guidelines are supported as an important adjunct to the clinical management of migraine headaches in children.

Effects of a mass media behavioral treatment for chronic headache: a pilot study.

This article presents the results of a pilot study evaluating the efficacy of a mass media self-help behavioral treatment program for chronic headache. The program consisted of a self-help textbook, an exercise book, 10 television programs, 11 radio programs, and 3 audiocassettes with relaxation training. Approximately 15,000 headache sufferers purchased the book and relaxation tapes. A random sample of 271 respondents participated in the effect study; the pretraining and posttraining data of 164 subjects were available for analysis. Multivariate testing of the pretraining and posttraining results showed highly significant reductions in headache activity and medication intake at 4-month follow-up. A reduction of 50% or more in headache parameters and medication intake was achieved by 40% to 60% of the patients. Work absenteeism was significantly reduced. The differences between the diagnostic groups were not significant. Mass media behavioral treatment seems to be a viable treatment alternative for chronic headache and highly promising in terms of gain in quality of life, decrease in economic loss, and cost-effectiveness in health care.

Self-efficacy in the thermal biofeedback treatment of migraine sufferers

Despite the demonstrated efficacy of thermal biofeedback (TBF) for the treatment of migraine headaches, therapeutic mechanisms underlying this widely used therapy remain poorly understood. Previous investigations of electromyograph (EMG) biofeedback treatment of tension-type headache have suggested that reductions in headache activity may be mediated primarily by changes in perceived self-efficacy, rather than actual self-regulation ability. The present study examined perceived self-efficacy as a potential therapeutic mechanism in TBF using an experimental manipulation of perceived success. Twenty-seven females meeting International Headache Society (IHS) diagnostic criteria for migraine headache were randomly assigned to one of two TBF conditions. Subjects were shown bogus computer-generated graphs that ostensibly demonstrated that subjects displayed either superior (high success condition) or inferior (moderate success condition) hand-warming skills relative to a fictitious normative sample. Although the manipulation of perceived success produced significant group differences on measures of perceived self-efficacy, the groups did not experience significantly different reductions in headache activity or medication consumption. The present findings suggest that perceived self-efficacy, as measured in the present study, may not be a significant mediator of TBF treatment outcome.

Maintenance of Effects in the Nonmedical Treatment of Headaches During Pregnancy

In a previous study, 30 pregnant women suffering from headaches were treated with physical therapy, relaxation training, and biofeedback. Eighty percent of these women experienced significant relief of headaches following treatment. Although this study demonstrated the effectiveness of nonmedical treatment during pregnancy, little is known about the influence of changing hormones during pregnancy on fluctuations in headache. One purpose of this study was to present a follow-up of the women who were included in the previous study to determine whether the results from the nonmedical treatment were maintained up to a year after giving birth. In addition, this study examined the influence of headache diagnosis and breastfeeding on changes in headache activity and maintenance of treatment effects. The results indicate that the reductions in headache activity were maintained at follow-up in the majority of the women treated, with 67.5% of the sample maintaining a significant decrease in headache up to 1 year after giving birth. Neither IHS diagnosis nor breastfeeding was related to maintenance of headache improvement. We conclude that the beneficial effects of nonpharmacological treatment of headaches during pregnancy demonstrated in a previous study are maintained up to 1 year following delivery. Headache diagnosis and breastfeeding were not related to treatment outcome, a finding that contradicts the reports of many retrospective studies.

Interdisciplinary Outpatient Group Treatment of Intractable Headache

Approximately 10% of adults suffer from severe or disabling headaches. For many patients, headaches are reduced with traditional medical, physical, or psychological therapies. However, a significant minority continue to report debilitating headaches despite the use of these conventional therapies. An integrated, interdisciplinary approach combining these three individual components in a group treatment setting was offered to patients who had failed previous therapy. The interdisciplinary treatment resulted in over 70% of patients experiencing a 50% or better reduction in headaches at follow-up of an average of 5.8 months. Overall, there was an average reduction in medication use at follow-up of 71%. The treated group reported significantly greater reduction in headache activity and medication consumption compared to a group that was referred to but did not receive group treatment. The results suggest that an interdisciplinary outpatient group treatment may provide a cost-effective and time-efficient treatment option for patients with a variety of recurring headaches, even if they have failed conventional therapies that use medical, physical, and psychological treatments individually.

Home‐Based Multicomponent Treatment of Pediatric Migraine

The present investigation examined a home-based multicomponent treatment program incorporating biobehavioral technology in the treatment of pediatric migraine. Twenty-one children ages 7-12 participated in home-based practice of thermal biofeedback while parents implemented guidelines designed to encourage the use of biofeedback and eliminate support for maladaptive pain behavior. Treatment was introduced sequentially across three groups of children in a multiple baseline design. When subjects and their families were complaint with treatment recommendations, 87% of the children experienced clinically significant reductions in headache activity, with these reductions maintained at 3 and 8 month followups. Treatment outcome was found to be closely related to frequency of home practice, parental support for the use of adaptive coping (biofeedback) rather than maladaptive coping (pain) behaviors, and ability to warm hands. Discussion is provided concerning potential mechanisms of action and directions for future research.

Treatment of a 15‐year‐old girl with chronic muscle‐contraction headache using implosive therapy

A 15-year-old girl with chronic muscle-contraction headache was treated initially using a behaviourally based headache programme. Little change in headache activity resulted. Implosive therapy was incorporated into treatment after the girl revealed a past episode of sexual abuse. A substantial reduction in headache activity was noted at post-treatment and follow-up.

The role of regular home practice in the relaxation treatment of tension headache.

This study evaluated the contribution of regular home practice in the treatment of tension headache (HA) with progressive muscle relaxation (PMR) by giving 14 tension HA sufferers 10 sessions (over 8 weeks) of standard PMR with home practice and application instructions while 13 additional patients received the same PMR training (except for the omission of cue-controlled relaxation) with no home practice or application instruction. A third group of 6 patients merely monitored HA activity. Both treated groups showed significant reduction in HA activity, whereas the symptom monitoring group did not change. The 2 treated groups did not differ. On a measure of clinically significant reduction in HA activity (at least 50% reduction in HA activity), however, the group receiving home practice instruction (50%) showed a trend (p = .056) to improve more than did those receiving PMR without home practice (15%).

A Controlled Evaluation of the Addition of Cognitive Therapy to a Home‐Based Biofeedback and Relaxation Treatment of Vascular Headache

Seventy-six patients with vascular (migraine or mixed migraine and tension) headache (HA) participated in a controlled evaluation of a minimal-therapist-contact, largely home-based, treatment program which combined relaxation (R) training with thermal biofeedback (TBF). One group received TBF + R administered in 3 office visit over 8 weeks, supplemented by audio tapes and manuals. A second group received the TBF + R plus instruction in cognitive stress coping techniques, all of which was administered in 5 office visits over 8 weeks. A third group monitored headache activity for 8 weeks. Evaluations, based on 4 weeks of HA diary at pre-treatment and after treatment, revealed significantly greater reductions in HA activity and medication consumption for both treated groups than the HA monitoring controls who did not change. Significantly more of the treated patients had clinically significant reductions in HA activity than the controls. The two treated groups did not differ on any measure.

Controlled evaluation of the addition of cognitive strategies to a home-based relaxation protocol for tension headache

Chronic tension headache sufferers were randomized in the approximate ratio of 2:2:1 to one of three regimens: (1) progressive muscle relaxation (PMR) training delivered as a largely home-based treatment; (2) PMR plus selected cognitive stress coping techniques, again delivered as a largely home-based treatment; or (3) a headache monitoring, wait-list control condition. All patients monitored headaches daily for at least 4 weeks before and after treatment. In general, the two active treatment groups were significantly improved relative to the wait-list control group on measures of reduction in headache activity and reduction in headache medication, derived from a daily headache diary, and on measures of clinically significant improvement. The two active treatment groups did not differ from each other on any measure. Thus, it appears that the addition of limited cognitive stress-coping techniques to PMR did not add significantly to treatment outcome utilizing the protocol described.

Enhancing the Effectiveness of Abortive Therapy: A Controlled Evaluation of Self‐Management Training

Research suggests that approximately one half of recurrent headache sufferers fail to adhere properly to drug treatment regimens with as many as two thirds of patients failing to make optimal use of abortive medications such as ergotamine. In spite of these findings there are no controlled studies that have attempted to evaluate methods for improving adherence to drug regimens for the treatment of chronic headache disorders. In an initial effort to address this adherence problem thirty-four recurrent migraine sufferers were randomized to abortive therapy with ergotamine tartrate plus caffeine (standard abortive therapy) or to standard abortive therapy accompanied by a brief educational intervention designed to facilitate the migraine sufferer's effective use of ergotamine. Patients who received the adjunctive educational intervention attempted to abort a greater percentage of their migraine attacks (70% vs 40%) and showed larger reduction in headache activity (e.g., 40% vs 26% reduction in month two of treatment). However, patients in both treatment groups used similar amounts of abortive medication when attempting to abort a migraine attack and showed similar reductions in analgesic medication use with abortive therapy. There results suggest that brief educational interventions designed to address the problem of patient adherence may yield significant improvements in standard therapies. We argue that such educational interventions deserve more attention in the headache treatment literature than they have received to date.

Two studies of the potential mechanisms of action in the thermal biofeedback treatment of vascular headache.

Sixty vascular headache sufferers who underwent a standard protocol treatment of progressive relaxation and thermal biofeedback with autogenic training were studied for changes in hand temperature (the targeted response) and heart rate (a non-targeted response) to determine how such physiological change relates to reduction in headache activity. Overall, regardless of degree of improvement, subjects showed a significant, positive change over time in their ability to increase hand temperature. It was also found that inability to handwarm at session one of thermal biofeedback training was predictive of treatment success, as was the ability to achieve a fingertip temperature of at least 96.0 degrees F at any point in thermal biofeedback training. In addition, it was found that migraine headache sufferers who were treatment successes had significantly lowered their heart rates from pre- to post-treatment assessment.

Development and clinical trial of a minimal contact, cognitive-behavioral treatment for tension headache

The effectiveness of two primarily self-administered treatments for chronic tension headache were compared. Twenty-four recurrent tension headache sufferers received either relaxation therapy alone or relaxation training plus cognitive-behavioral therapy in a primarily self-administered treatment format. Both treatments yielded substantial reductions in headache activity and smaller but significant reductions in depression. However, patients who received the combined treatment recorded significantly larger reductions in headache activity than patients receiving relaxation training alone. In addition, high pretreatment levels of headache activity and daily life stress were associated with a poor response to relaxation training but were unrelated to patients' response to the combined treatment. These results suggest that cognitive-behavioral interventions may enhance the effectiveness of primarily self-administered relaxation training, particularly with selected subgroups of patients.

Chronic headaches in adolescents: Treatment in a school setting with relaxation training as compared with information-contact and self-registration

An experimental study was conducted on 33 adolescent students with various types of chronic headaches (tension and combined tension and migraine headaches), all treated in a school setting. After a 4-week baseline period during which the subjects rated their headache activity, they were randomly assigned to a 9-session relaxation training programme or to an information-contact condition, both contrasted with an untreated self-registration group. Relaxation therapy alone led to significant improvement in headache activity, particularly in reduction of the frequency of complaints which still was significantly reduced at a 6-month follow-up evaluation. The effects obtained in the information-contact condition were comparable to those in the self-registration group, both achieving only minor improvements after treatment or at the follow-up assessment. The majority of students in the relaxation treatment, however, was much improved, attaining more than 50% reduction in headache activity. The findings in the present study are consistent with results from similar treatment outcome studies, reported on adult populations with chronic headaches, and demonstrate that relaxation training programmes can be of substantial help in a school setting.

EMG biofeedback and the treatment of tension headaches: A systematic analysis of treatment components

Thirty-two chronic headache sufferers were randomly assigned to one of four treatment groups. One group received contingent EMG feedback with instructions to lower muscle activity using the feedback. The second group received contingent EMG feedback with instruction to maintain basal muscle activity levels using the feedback. A third group, an attention placebo control, meditated on a noncontingent feedback tone. The fourth group controlled for the effects of hourly headache charting and notations of headache prone situations. Only the two EMG feedback groups showed a significant reduction in headache activity. At the 6-month follow-up, the EMG-induced relaxation group had begun to show a return of headache activitym, while the EMG stability training group evidenced a continued reduction in headache activity. These findings provide strong support for the assumption that EMG feedback is a critical component in the treatment of tension heacaches and further suggest a possible procedure to facilitate the transfer of therapeutic gains.

Feedback-induced muscle relaxation: Application to tension headache

This paper describes a technique for producing deep muscle relaxation by means of an information feedback technique—the subject hears a tone with a frequency proportional to the EMG level of the muscle being monitored. The new technique was applied to several tension headache patients—the first five individuals available for the study. With this ‘bio-feedback’ training in relaxation, the patients not only learned to produce low frontalis EMG levels but showed subsequent reductions in headache activity.