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Gladys Vallespir Ellett - One of the best experts on this subject based on the ideXlab platform.
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behavioral therapies and mind body interventions for Posttraumatic Headache and post concussive symptoms a systematic review
Headache, 2019Co-Authors: Mia T. Minen, Sarah Jinich, Gladys Vallespir EllettAbstract:Background There are no clear guidelines on how to treat Posttraumatic Headache (PTH) or post-concussive symptoms (PCS). However, behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation are Level-A evidence-based treatments for Headache prevention. To understand how to develop and study further mind-body interventions (MBIs) and behavioral therapies for PTH and PCS, we developed the following question using the PICO framework: Are behavioral therapies and MBIs effective for treating PTH and PCS? Methods We conducted a systematic search of 3 databases (Medline, PsycINFO, and EMBASE) for behavioral interventions and MBIs with the subject headings and keywords for PTH, concussion, and traumatic brain injury (TBI). Inclusion criteria were (1) randomized controlled trials, (2) the majority of the intervention had to be behavioral or mind-body therapy focused, (3) the majority of the participants (>50%) had to have had a mild TBI (not a moderate or severe TBI), (4) published in a peer-reviewed publication, and (5) meeting pre-specified primary and/or secondary outcomes. Primary outcome(s): whether there was a significant change in concussion symptom severity (yes/no) based on the symptom severity checklist/scale used, whether there was a 50% reduction in Headache days and/or disability; secondary outcome(s): sleep variables, cognitive complaints, depression, and anxiety. The search identified 917 individual studies. Two independent reviewers screened citations and full-text articles independently. Nineteen articles were pulled for full article review. Seven articles met the final inclusion criteria. The systematic review was registered in Prospero (CRD42017070072). Results Overall, there was vast heterogeneity across the studies, making it difficult to fully assess efficacy. The heterogeneity ranged from differences in patient populations, the timing of when the interventions were initiated, the types of intervention implemented, and the measures used to assess outcomes. Seven studies were identified as meeting final inclusion criteria, resulting in a total of 1108 adult participants ranging from 18 to 80. Sixty-nine percent were male. Of the 7 studies, 3 were focused on military staff (retired and active). Time post-injury for inclusion into the studies varied from 48 hours post-injury to more than 2 years post-injury. One of the 7 studies did not include time post-TBI in the inclusion criteria. Two studies recruited patients who had visited their emergency departments, 4 of the studies recruited subjects through outpatient referrals, and 1 study recruited patients who had been in a prior traffic accident with resulting chronic PTH directly from a Headache center. Group cognitive behavioral therapy (CBT) sessions and telephonic counseling or communication were common intervention methods used in the studies, with group CBT being used in 2 of the studies and telephonic counseling being used in 3. Other intervention methods used included individual CBT, cognitive training, psychoeducation, and computer-based and/or therapist-directed cognitive rehabilitation. Conclusions Many of the interventions offered vastly different methods of delivery of intervention and doses of intervention. Many of the negative studies were done after an extended duration post-injury (>1-year Posttraumatic brain injury [TBI]). In addition, the participants were lumped together regardless of their pre-concussion comorbidities, their mechanism of injury, their symptoms, and the duration from injury to the start of the intervention. The mass heterogeneity found between the studies led to inconclusive findings. Thus, there are various considerations for the design of the intervention for future behavioral/MBI studies for PTH and concussion that must be addressed before the leading question of this review may be effectively answered.
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Behavioral Therapies and Mind‐Body Interventions for Posttraumatic Headache and Post‐Concussive Symptoms: A Systematic Review
Headache, 2018Co-Authors: Mia T. Minen, Sarah Jinich, Gladys Vallespir EllettAbstract:Background There are no clear guidelines on how to treat Posttraumatic Headache (PTH) or post-concussive symptoms (PCS). However, behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation are Level-A evidence-based treatments for Headache prevention. To understand how to develop and study further mind-body interventions (MBIs) and behavioral therapies for PTH and PCS, we developed the following question using the PICO framework: Are behavioral therapies and MBIs effective for treating PTH and PCS? Methods We conducted a systematic search of 3 databases (Medline, PsycINFO, and EMBASE) for behavioral interventions and MBIs with the subject headings and keywords for PTH, concussion, and traumatic brain injury (TBI). Inclusion criteria were (1) randomized controlled trials, (2) the majority of the intervention had to be behavioral or mind-body therapy focused, (3) the majority of the participants (>50%) had to have had a mild TBI (not a moderate or severe TBI), (4) published in a peer-reviewed publication, and (5) meeting pre-specified primary and/or secondary outcomes. Primary outcome(s): whether there was a significant change in concussion symptom severity (yes/no) based on the symptom severity checklist/scale used, whether there was a 50% reduction in Headache days and/or disability; secondary outcome(s): sleep variables, cognitive complaints, depression, and anxiety. The search identified 917 individual studies. Two independent reviewers screened citations and full-text articles independently. Nineteen articles were pulled for full article review. Seven articles met the final inclusion criteria. The systematic review was registered in Prospero (CRD42017070072). Results Overall, there was vast heterogeneity across the studies, making it difficult to fully assess efficacy. The heterogeneity ranged from differences in patient populations, the timing of when the interventions were initiated, the types of intervention implemented, and the measures used to assess outcomes. Seven studies were identified as meeting final inclusion criteria, resulting in a total of 1108 adult participants ranging from 18 to 80. Sixty-nine percent were male. Of the 7 studies, 3 were focused on military staff (retired and active). Time post-injury for inclusion into the studies varied from 48 hours post-injury to more than 2 years post-injury. One of the 7 studies did not include time post-TBI in the inclusion criteria. Two studies recruited patients who had visited their emergency departments, 4 of the studies recruited subjects through outpatient referrals, and 1 study recruited patients who had been in a prior traffic accident with resulting chronic PTH directly from a Headache center. Group cognitive behavioral therapy (CBT) sessions and telephonic counseling or communication were common intervention methods used in the studies, with group CBT being used in 2 of the studies and telephonic counseling being used in 3. Other intervention methods used included individual CBT, cognitive training, psychoeducation, and computer-based and/or therapist-directed cognitive rehabilitation. Conclusions Many of the interventions offered vastly different methods of delivery of intervention and doses of intervention. Many of the negative studies were done after an extended duration post-injury (>1-year Posttraumatic brain injury [TBI]). In addition, the participants were lumped together regardless of their pre-concussion comorbidities, their mechanism of injury, their symptoms, and the duration from injury to the start of the intervention. The mass heterogeneity found between the studies led to inconclusive findings. Thus, there are various considerations for the design of the intervention for future behavioral/MBI studies for PTH and concussion that must be addressed before the leading question of this review may be effectively answered.
Howard Jacobs - One of the best experts on this subject based on the ideXlab platform.
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Subcutaneous Sumatriptan in the Treatment of Acute Episodes of Posttraumatic Headache
Headache, 1993Co-Authors: Marek Gawel, Peter Rothbart, Howard JacobsAbstract:SYNOPSIS Seven patients with Posttraumatic Headaches refractory to other medical treatment were treated with sumatriptan, 6 mg subcutaneously, at the peak of a Headache. In all, the throbbing temporal part of the Headache disappeared leaving a persistent occipital pain. It is postulated that involvement of the trigeminovascular system is involved in part of the pain of Posttraumatic Headache, making it amenable to treatment with sumatriptan.
Lesley P. Ham - One of the best experts on this subject based on the ideXlab platform.
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Pathogenesis of Posttraumatic Headache and migraine: a common Headache pathway?
Headache, 1997Co-Authors: Russell C. Packard, Lesley P. HamAbstract:In recent years, research implicating biochemical abnormalities in various pathological conditions has spiralled. Headache is an area in which numerous research studies have been conducted examining biochemical alterations. We have noticed several similarities in biochemical changes reported to occur in migraine and in experimental traumatic brain injury. The most common symptom in mild head injury or mild traumatic brain injury is Headache which, in many instances, resembles migraine but has a poorly understood pathophysiology. Biochemical mechanisms believed to be similar in both conditions include: increased extracellular potassium and intracellular sodium, calcium, and chloride; excessive release of excitatory amino acids; alterations in serotonin; abnormalities in catecholamines and endogenous opioids; decline in magnesium levels and increase in intracellular calcium; impaired glucose utilization; abnormalities in nitric oxide formation and function; and alterations in neuropeptides. In this paper, these proposed biochemical alterations will be reviewed and compared. Very similar alterations suggest Posttraumatic Headache associated with mild head injury and migraine may share a common Headache pathway.
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JOURNAL OF NEUROPSYCHIATRY 229 Posttraumatic Headache
1994Co-Authors: Russell C. Packard, Lesley P. HamAbstract:The authors review Posttraumatic Headache (PTH). The most common symptom following head injury, PTH is paradoxically most severe after mild head injury. Although most cases re-solve within 6 to 12 months, many patients have protracted or even permanent Headache. Because PTH generally has no objective findings, it is often controversial whether the symptom is “real,” “psychogenic, ” or “fabricated. ” Despite persisting beliefs by physicians, attorneys, and insurers that PTH resolves upon legal settlement, recent studies have shown that “permanent ” PTH is usually still present several years after a legal settlement. Often PTH affects family life, recreation, and employment. Patients require education and support as well as appropriate evaluation and treatment. (The Journal of Neuropsychiatry and Clinica
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Posttraumatic Headache: Determining Chronicity
Headache, 1993Co-Authors: Russell C. Packard, Lesley P. HamAbstract:SYNOPSIS In the Headache literature, there exists a great deal of discrepancy regarding when Posttraumatic Headache (PTH) may be classified as chronic. Although chronic pain is usually described as pain persisting for longer than six months, many view chronic Posttraumatic Headache as persisting for more than two months, including the International Headache Society criteria. Observations made by Brenner and Friedman in 1944 have been repeatedly cited for this determination. Surprisingly, a review of this original source revealed that the term “chronic“ was never used when discussing Posttraumatic Headache over two months duration. The authors, in fact, suggested two months as an “arbitrary” dividing line. Recent studies suggest that many patients with PTH continue to improve or change over the first six months but start to plateau after that time. We feel six months serves as a better time indicator for defining chronicity in cases of Posttraumatic Headache. This would be more consistent with the current literature concerning chronic pain and the International Headache Society criteria for chronic tension Headache.
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Impairment Ratings for Posttraumatic Headache
Headache, 1993Co-Authors: F.a.c.p. Russell C. Packard, Lesley P. HamAbstract:SYNOPSIS No standardized criteria are available for establishing impairment ratings for pain or Posttraumatic Headache. The AMA Guides to the Evaluation of Permanent Impairment, 3rd Edition, 1988, defines impairment as “the loss of use of, or derangement of any body part, system or function.” Headaches may be classified under episodic neurological disorders and impairment based loosely on frequency, severity and duration of attacks and how activities of daily living are affected. Other systems base ratings by physical findings or diagnosis. Criteria for Posttraumatic Headache are proposed in the form of a mnemonic: I M P A I R M E N T. Intensity, Medication use, Physical signs/symptoms, Adjustment, Incapacitation, Recreation, Miscellaneous activity of daily living, Employment, Number (frequency), Time (duration of attacks). Each are scored from 0 to 2 points. There are three physician modifiers, scored from 0 to -4 points: Motivation for treatment, Overexaggeration or overconcern, Degree of legal interest. Case examples will illustrate how impairment ratings are determined, along with further details on scoring. Proposed criteria for Posttraumatic Headache impairment are understandable, easy to utilize and reproducible.
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Cognitive symptoms in patients with Posttraumatic Headache.
Headache, 1993Co-Authors: F.a.c.p. Russell C. Packard, Richard Weaver, Lesley P. HamAbstract:SYNOPSIS A variety of symptoms (postconcussion symptoms) have been consistently reported following mild head or neck injury. One symptom which may have been under reported is cognitive impairment. We conducted a retrospective study of 100 patients presenting for evaluation and treatment of Posttraumatic Headache at our Headache clinic. Sixty-five percent reported difficulties with either memory, concentration, and/or thinking. The most common cognitive symptoms reported were concentration + memory problems, concentration + memory + thinking difficulties, concentration disturbances, and difficulty remembering, respectively. Subjects in both groups (with cognitive symptoms and without cognitive symptoms) were similar in age, but females seemed more predisposed than males to cognitive impairment following mild head injury. it is suggested that clinicians thoroughly evaluate patients for cognitive symptoms, particularly when patients have a permanent condition and are subsequently involved in litigation.
Russell C. Packard - One of the best experts on this subject based on the ideXlab platform.
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Treatment of chronic daily Posttraumatic Headache with divalproex sodium
Headache, 2000Co-Authors: Russell C. PackardAbstract:Objective.—To determine the effectiveness of divalproex sodium in the treatment of chronic daily Posttraumatic Headaches. Background.—Divalproex sodium has been found to be useful for the treatment of migraine and chronic daily Headache. No studies have been done to evaluate effectiveness in Posttraumatic Headache. Methods.—A retrospective review was done of 100 patients treated with divalproex for chronic daily Posttraumatic Headache of 2 months or longer. Results.—Sixty percent of patients with chronic Posttraumatic Headache had mild to moderate improvement in their Headaches after at least 1 month of divalproex sodium. Forty percent either showed no response (26%) or discontinued treatment because of side effects (14%). Fifty-eight percent of patients showing improvement had a change in Headache pattern from daily to episodic. Conclusions.—Divalproex sodium appears to be safe and effective for treatment of patients with persistent, chronic daily Posttraumatic Headaches.
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Epidemiology and pathogenesis of Posttraumatic Headache
The Journal of head trauma rehabilitation, 1999Co-Authors: Russell C. PackardAbstract:This article presents an overview of the epidemiology and pathophysiology of Posttraumatic Headache. It reviews definitions of mild head injury (MHI), mild traumatic brain injury (MTBI), and concussion, and discusses the confusion that often occurs with these terms. Headache types and their pathophysiology are examined in detail. Just as the exact pathophysiology is unknown for migraine and other types of Headache, the exact pathophysiology of Headache after trauma is also still unknown in many cases. Possible connections between head or neck injuries and Headache are reviewed, as well as hypothesized neurochemical changes that may occur in both migraine and traumatic brain injury (TBI). Psychological and legal factors are also considered.
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Pathogenesis of Posttraumatic Headache and migraine: a common Headache pathway?
Headache, 1997Co-Authors: Russell C. Packard, Lesley P. HamAbstract:In recent years, research implicating biochemical abnormalities in various pathological conditions has spiralled. Headache is an area in which numerous research studies have been conducted examining biochemical alterations. We have noticed several similarities in biochemical changes reported to occur in migraine and in experimental traumatic brain injury. The most common symptom in mild head injury or mild traumatic brain injury is Headache which, in many instances, resembles migraine but has a poorly understood pathophysiology. Biochemical mechanisms believed to be similar in both conditions include: increased extracellular potassium and intracellular sodium, calcium, and chloride; excessive release of excitatory amino acids; alterations in serotonin; abnormalities in catecholamines and endogenous opioids; decline in magnesium levels and increase in intracellular calcium; impaired glucose utilization; abnormalities in nitric oxide formation and function; and alterations in neuropeptides. In this paper, these proposed biochemical alterations will be reviewed and compared. Very similar alterations suggest Posttraumatic Headache associated with mild head injury and migraine may share a common Headache pathway.
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A retrospective, follow-up study of biofeedback-assisted relaxation therapy in patients with Posttraumatic Headache
Biofeedback and Self-regulation, 1996Co-Authors: Russell C. PackardAbstract:Although biofeedback in the treatment of migraine and tension-type Headache has been widely researched, there is little research examining biofeedback therapy in Posttraumatic Headache (PTH). In this retrospective study, 40 subjects with PTH who had received biofeedback-assisted relaxation at our Headache clinic were questioned at least 3 months following the completion of therapy. Subjects were queried about improvements in Headache, increases in ability to relax and cope with pain, and overall benefits, lasting effectiveness, and continued use of biofeedback in daily life. Results indicate 53% reported at least moderate improvement in Headaches; 80% reported at least moderate improvement in ability to relax and cope with pain; 93% found biofeedback helpful to some degree; 85% felt Headache relief achieved through biofeedback had continued at least somewhat; and 95% stated they were continuing to use biofeedback skills in daily life. A correlation analysis revealed a negative relationship between response to biofeedback and increased chronicity of the disorder. In other words, the more chronic the disorder, the poorer the response to treatment. A stepwise regression analysis found that chronicity of the disorder and number of treatment sessions significantly affected response to treatment. Data suggest that biofeedback-assisted relaxation should at least be considered when planning treatment strategies for Posttraumatic Headache.
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JOURNAL OF NEUROPSYCHIATRY 229 Posttraumatic Headache
1994Co-Authors: Russell C. Packard, Lesley P. HamAbstract:The authors review Posttraumatic Headache (PTH). The most common symptom following head injury, PTH is paradoxically most severe after mild head injury. Although most cases re-solve within 6 to 12 months, many patients have protracted or even permanent Headache. Because PTH generally has no objective findings, it is often controversial whether the symptom is “real,” “psychogenic, ” or “fabricated. ” Despite persisting beliefs by physicians, attorneys, and insurers that PTH resolves upon legal settlement, recent studies have shown that “permanent ” PTH is usually still present several years after a legal settlement. Often PTH affects family life, recreation, and employment. Patients require education and support as well as appropriate evaluation and treatment. (The Journal of Neuropsychiatry and Clinica
Mia T. Minen - One of the best experts on this subject based on the ideXlab platform.
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behavioral therapies and mind body interventions for Posttraumatic Headache and post concussive symptoms a systematic review
Headache, 2019Co-Authors: Mia T. Minen, Sarah Jinich, Gladys Vallespir EllettAbstract:Background There are no clear guidelines on how to treat Posttraumatic Headache (PTH) or post-concussive symptoms (PCS). However, behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation are Level-A evidence-based treatments for Headache prevention. To understand how to develop and study further mind-body interventions (MBIs) and behavioral therapies for PTH and PCS, we developed the following question using the PICO framework: Are behavioral therapies and MBIs effective for treating PTH and PCS? Methods We conducted a systematic search of 3 databases (Medline, PsycINFO, and EMBASE) for behavioral interventions and MBIs with the subject headings and keywords for PTH, concussion, and traumatic brain injury (TBI). Inclusion criteria were (1) randomized controlled trials, (2) the majority of the intervention had to be behavioral or mind-body therapy focused, (3) the majority of the participants (>50%) had to have had a mild TBI (not a moderate or severe TBI), (4) published in a peer-reviewed publication, and (5) meeting pre-specified primary and/or secondary outcomes. Primary outcome(s): whether there was a significant change in concussion symptom severity (yes/no) based on the symptom severity checklist/scale used, whether there was a 50% reduction in Headache days and/or disability; secondary outcome(s): sleep variables, cognitive complaints, depression, and anxiety. The search identified 917 individual studies. Two independent reviewers screened citations and full-text articles independently. Nineteen articles were pulled for full article review. Seven articles met the final inclusion criteria. The systematic review was registered in Prospero (CRD42017070072). Results Overall, there was vast heterogeneity across the studies, making it difficult to fully assess efficacy. The heterogeneity ranged from differences in patient populations, the timing of when the interventions were initiated, the types of intervention implemented, and the measures used to assess outcomes. Seven studies were identified as meeting final inclusion criteria, resulting in a total of 1108 adult participants ranging from 18 to 80. Sixty-nine percent were male. Of the 7 studies, 3 were focused on military staff (retired and active). Time post-injury for inclusion into the studies varied from 48 hours post-injury to more than 2 years post-injury. One of the 7 studies did not include time post-TBI in the inclusion criteria. Two studies recruited patients who had visited their emergency departments, 4 of the studies recruited subjects through outpatient referrals, and 1 study recruited patients who had been in a prior traffic accident with resulting chronic PTH directly from a Headache center. Group cognitive behavioral therapy (CBT) sessions and telephonic counseling or communication were common intervention methods used in the studies, with group CBT being used in 2 of the studies and telephonic counseling being used in 3. Other intervention methods used included individual CBT, cognitive training, psychoeducation, and computer-based and/or therapist-directed cognitive rehabilitation. Conclusions Many of the interventions offered vastly different methods of delivery of intervention and doses of intervention. Many of the negative studies were done after an extended duration post-injury (>1-year Posttraumatic brain injury [TBI]). In addition, the participants were lumped together regardless of their pre-concussion comorbidities, their mechanism of injury, their symptoms, and the duration from injury to the start of the intervention. The mass heterogeneity found between the studies led to inconclusive findings. Thus, there are various considerations for the design of the intervention for future behavioral/MBI studies for PTH and concussion that must be addressed before the leading question of this review may be effectively answered.
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Behavioral Therapies and Mind‐Body Interventions for Posttraumatic Headache and Post‐Concussive Symptoms: A Systematic Review
Headache, 2018Co-Authors: Mia T. Minen, Sarah Jinich, Gladys Vallespir EllettAbstract:Background There are no clear guidelines on how to treat Posttraumatic Headache (PTH) or post-concussive symptoms (PCS). However, behavioral interventions such as cognitive behavioral therapy, biofeedback, and relaxation are Level-A evidence-based treatments for Headache prevention. To understand how to develop and study further mind-body interventions (MBIs) and behavioral therapies for PTH and PCS, we developed the following question using the PICO framework: Are behavioral therapies and MBIs effective for treating PTH and PCS? Methods We conducted a systematic search of 3 databases (Medline, PsycINFO, and EMBASE) for behavioral interventions and MBIs with the subject headings and keywords for PTH, concussion, and traumatic brain injury (TBI). Inclusion criteria were (1) randomized controlled trials, (2) the majority of the intervention had to be behavioral or mind-body therapy focused, (3) the majority of the participants (>50%) had to have had a mild TBI (not a moderate or severe TBI), (4) published in a peer-reviewed publication, and (5) meeting pre-specified primary and/or secondary outcomes. Primary outcome(s): whether there was a significant change in concussion symptom severity (yes/no) based on the symptom severity checklist/scale used, whether there was a 50% reduction in Headache days and/or disability; secondary outcome(s): sleep variables, cognitive complaints, depression, and anxiety. The search identified 917 individual studies. Two independent reviewers screened citations and full-text articles independently. Nineteen articles were pulled for full article review. Seven articles met the final inclusion criteria. The systematic review was registered in Prospero (CRD42017070072). Results Overall, there was vast heterogeneity across the studies, making it difficult to fully assess efficacy. The heterogeneity ranged from differences in patient populations, the timing of when the interventions were initiated, the types of intervention implemented, and the measures used to assess outcomes. Seven studies were identified as meeting final inclusion criteria, resulting in a total of 1108 adult participants ranging from 18 to 80. Sixty-nine percent were male. Of the 7 studies, 3 were focused on military staff (retired and active). Time post-injury for inclusion into the studies varied from 48 hours post-injury to more than 2 years post-injury. One of the 7 studies did not include time post-TBI in the inclusion criteria. Two studies recruited patients who had visited their emergency departments, 4 of the studies recruited subjects through outpatient referrals, and 1 study recruited patients who had been in a prior traffic accident with resulting chronic PTH directly from a Headache center. Group cognitive behavioral therapy (CBT) sessions and telephonic counseling or communication were common intervention methods used in the studies, with group CBT being used in 2 of the studies and telephonic counseling being used in 3. Other intervention methods used included individual CBT, cognitive training, psychoeducation, and computer-based and/or therapist-directed cognitive rehabilitation. Conclusions Many of the interventions offered vastly different methods of delivery of intervention and doses of intervention. Many of the negative studies were done after an extended duration post-injury (>1-year Posttraumatic brain injury [TBI]). In addition, the participants were lumped together regardless of their pre-concussion comorbidities, their mechanism of injury, their symptoms, and the duration from injury to the start of the intervention. The mass heterogeneity found between the studies led to inconclusive findings. Thus, there are various considerations for the design of the intervention for future behavioral/MBI studies for PTH and concussion that must be addressed before the leading question of this review may be effectively answered.