There are a vast number of treatment options available for Migraine prevention ranging pharmacological medications to complementary therapies and dietary supplements. I've written on the necessity for Migraine patients and anyone diagnosed with a chronic illness to be well educated on the intricacies of living with said illness and all available treatment choices. Many times medical professionals use medication as the first line of treatment without considering other, non-pharmacological options. At the American Headache Society's (AHS) 54th Annual Scientific Meeting this past June, the poster presentation; Knowledge, Attitudes and Beliefs about Behavioral Treatments for Migraine: A Survey of AHS Members was intriguing. It was a survey distributed to AHS members examining the familiarity and thoughts about using behavioral treatments to help prevent Migraine in some patients.
Over 750 AHS members were asked to take part in an online questionnaire to evaluate their understanding and viewpoints of how and if they used behavioral treatments in their practice, their referral habits and associated beliefs. The respondents included Migraine specialists (some of who are mental healthcare professionals) psychologists, nurse practitioners and physician's assistants. The majority of respondents were white, male physicians who suffered Migraine. The data collected detailed how these healthcare professionals assessed their patients psychological comorbidities; any non-pharmacological referral trends they had and which patients would be "best suited" for behavioral treatments. "Best suited" in this survey referred to patients who had trouble coping with Migraine/headache related disability; trouble managing their stress levels and/or Migraine triggers and those who experienced anxiety.
What the Data Showed
- Psychologists were the largest group who used "Grade A" (the best) behavioral treatments for prevention of Migraine, followed by migraine specialists, nurse practitioners and physician's assistants respectively.
- Biofeedback ranked highest these treatment options, followed by cognitive behavioral therapy (CBT) and relaxation therapy.
- Between 75% - 100% of respondents said it was customary for them to screen for depression.
- 50% of respondents screened for anxiety.
- Only 35% of respondents said they screened for abuse and/or post traumatic stress disorder (PTSD.)
- Overall referral rate for non-pharmacological treatments was well below 20% - which may be due to availability of services in some areas.
It seems most survey participants were not aware that biofeedback, CBT and/or relaxation therapy demonstrate "Grade A" choices for Migraine prevention. In fact, Dr. Rob Nicholson, lead study author said:
"we found low rates of referrals among Migraine treatment specialists for behavioral treatments for their patients. Reasons may include both a lack of knowledge about the value of such treatment as much as a lack of available referral services in local communities."
There is growing evidence showing some people with Migraine also have a history of abuse and/or PTSD, but it seems doctors are not actively screening their patients for these.
Comments and Considerations
This survey drives home the point that many treating physicians are not aware of "Grade A" Migraine treatment options. This in addition to the growing trend I see where patients will do just about anything to rid themselves of pain is quite concerning to me. Education is the key on both fronts; educating doctors that there are other, research backed alternatives to medication that may need to be explored and that Migraineurs need to be patient with their Migraine management plan. To accomplish this, doctors and patients need to work together to attain realistic rather than idealistic goals. As there is no cure yet for Migraine disease, a realistic Migraine management goal is a reduction in the frequency and severity of Migraines rather than becoming pain-free.
Nichoson, R.A,. Buse, D.C., Andrasik, F., Sollars, C.M., Lipton, R.B. " Knowledge, Attitudes and Beliefs about Behavioral Treatments for Migraine: A Survey of AHS Members." Poster Presentation. 54th Annual Scientific Meeting of the American Headache Society. June, 2012.
Photo; Flickr user paul bicca
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© HealthCentral Network, 2012.
Last updated December 18, 2012.
Published On: December 20, 2012