Bianca Meyer

Headache in children: update on biobehavioral treatments.

Biobehavioral pain treatment consists of relaxation techniques, biofeedback treatment, operant pain treatment, pain coping, cognitive-behavioral treatment, and multimodal treatment. Especially in the treatment of pediatric headache, biobehavioral procedures have been found to be highly efficient and are widely accepted. They present similar effects as pharmaceutical treatments. In general, when standardized treatment programs are applied, the sessions are highly effective.

Progressive muscle relaxation reduces migraine frequency and normalizes amplitudes of contingent negative variation (CNV).

BackgroundCentral information processing, visible in evoked potentials like the contingent negative variation (CNV) is altered in migraine patients who exhibit higher CNV amplitudes and a reduced habituation. Both characteristics were shown to be normalized under different prophylactic migraine treatment options whereas Progressive Muscle Relaxation (PMR) has not yet been examined. We investigated the effect of PMR on clinical course and CNV in migraineurs in a quasi-randomized, controlled trial.MethodsThirty-five migraine patients and 46 healthy controls were examined. Sixteen migraineurs and 21 healthy participants conducted a 6-week PMR-training with CNV-measures before and after as well as three months after PMR-training completion. The remaining participants served as controls. The clinical course was analyzed with two-way analyses of variance (ANOVA) with repeated measures. Pre-treatment CNV differences between migraine patients and healthy controls were examined with t-tests for independent measures. The course of the CNV-parameters was examined with three-way ANOVAs with repeated measures.ResultsAfter PMR-training, migraine patients showed a significant reduction of migraine frequency. Preliminary to the PMR-training, migraine patients exhibited higher amplitudes in the early component of the CNV (iCNV) and the overall CNV (oCNV) than healthy controls, but no differences regarding habituation. After completion of the PMR-training, migraineurs showed a normalization of the iCNV amplitude, but neither of the oCNV nor of the habituation coefficient.ConclusionsThe results confirm clinical efficacy of PMR for migraine prophylaxis. The pre-treatment measure confirms altered cortical information processing in migraine patients. Regarding the changes in the iCNV after PMR-training, central nervous mechanisms of the PMR-effect are supposed which may be mediated by the serotonin metabolism.

An update on behavioral treatments in migraine – current knowledge and future options

ABSTRACT Introduction: Besides pharmacological and interventional treatments a variety of non-medical therapeutic options exist for migraine, which has largely been derived from behavioral therapy. Areas covered: For our update we collected available studies via PubMed searches. This review highlights that already consulting of the patient is able to reduce the frequency of migraine attacks. Relaxation techniques, especially progressive muscle relaxation, and various types of biofeedback are effective, as is the implementation of cognitive behavioral therapy. However, recent reviews also point to some existing inconsistencies and methodological limitations. The advent of modern information technology based approaches (e.g. online therapy, smartphone applications) further advanced the arsenal of behavioral treatment regimes. The combination of behavioral treatment options and the combination with pharmacotherapy lead to additive effects. In modern multidisciplinary treatment approaches, behavioral therapy is an indispensable component. Expert commentary: Behavioral treatment in prophylaxis of migraine is as effective as pharmacological treatment with additional effects when pharmacological and behavioral treatment is applied in combination. Novel treatment approaches using online technology and electronic devices offer interesting options that will spread more in the future.

Nicht-medikamentöse Therapie der Migräne

Wenn Patienten mit Migräne in Ihrer Praxis Rat suchen, sollten Sie nicht nur Ihren Rezeptblock zücken. Mittlerweile gibt es auch für die Wirksamkeit verschiedener nicht-medikamentöser Verfahren gute Evidenz.

Midbrain raphe hypoechogenicity in migraineurs: An indicator for the use of analgesics but not triptans

Introduction The involvement of the serotonergic system of the brainstem raphe in the pathogenesis of migraine is discussed. Here we studied brainstem alterations in migraineurs using transcranial sonography and examined their relation to clinical features and self-medication. Methods We investigated 51 migraineurs (11 men, 40 women, mean age 29.7 ± 11.9 years) and 32 healthy individuals without history of headache or depressive disorder (eight men, 24 women, mean age 34.4 ± 13.0 years). Transcranial sonography was performed in an investigator-blinded fashion. Midbrain raphe echogenicity was quantified using digitized analysis. Migraine characteristics and the use of analgesics were evaluated by applying validated questionnaires. Eight migraineurs underwent neurophysiologic evaluation of contingent stimulus-related cortical potentials. Results Echo-reduced midbrain raphe was detected in 27 (53%) migraineurs, but only six (19%) control subjects (odds ratio = 4.87, p = 0.002). Lower raphe echogenicity correlated with both higher amplitude of terminal contingent negative variation (Spearman test, r = 0.76, p = 0.028) and higher use of analgesic drugs (r = −0.45, p = 0.011), but not with use of triptans or with migraine frequency or severity (all p > 0.2). Compared to migraineurs without aura, migraineurs with aura had enlarged third ventricles (t-test, p = 0.014), while the lateral ventricle widths did not differ (p = 0.62). Conclusions Midbrain raphe alteration is frequent in migraineurs and relates to self-medication behavior. This alteration may reflect the dysfunction of serotonergic raphe nuclei.

Indikationsstellung zur Verhaltenstherapie

ZusammenfassungDie Verhaltenstherapie basiert als anerkanntes Richtlinienverfahren auf den Grundlagen der Lerntheorie. Dabei gilt das Prinzip, dass erlerntes Verhalten auch wieder verlernt werden kann, was am Beispiel von Ängsten schon sehr früh angewendet wurde. Darüber hinaus spielten Kognitionen und Emotionen sowie achtsamkeitsbasierte Verfahren eine wichtige Rolle bei der verhaltenstherapeutischen Behandlung von psychischen Erkrankungen. Vorteile gegenüber anderen Richtlinienverfahren liegen in der schnellen und universellen Anwendbarkeit, im Gegenwartsbezug und in der Transparenz der Anwendung sowie in der Methodenvielfalt. Zusätzlich sind die Verfahren sehr evident und lassen sich sowohl selektiv als auch differenziell bei einer Vielzahl psychischer Erkrankungen einsetzen. Der Beitrag stellt die wichtigsten Erkrankungen unter dem Gesichtspunkt der Anwendung der verhaltenstherapeutischen Methoden zusammen. Aspekte einer differenziellen Indikation werden in Abhängigkeit von spezifischen Erkrankungen und Persönlichkeitseigenschaften diskutiert.AbstractBehavioral therapy is a recognized guideline-conform procedure based on the principles of learning theory. The principle is that behavior that has been learnt can also be forgotten again, which was applied very early on to the example of anxieties. Furthermore, cognition and emotions as well as attention-based procedures play an important role in the behavioral therapeutic treatment of mental illnesses. The advantages compared to other guideline procedures are the rapid and universal applicability, the contemporary relevance and the transparency of the application as well as the wide variety of methods. Additionally, the methods are very evident and can be selectively or differentially implemented for a multitude of mental illnesses. This article summarizes the most important illnesses from the perspective of the application of behavioral therapeutic methods. Aspects of differential indications are discussed in relation to specific illnesses and personality characteristics.

Migraine and Meditation: Characteristics of Cortical Activity and Stress Coping in Migraine Patients, Meditators and Healthy Controls-An Exploratory Cross-Sectional Study.

The aim of this exploratory cross-sectional study was to investigate the characteristics of cortical activity and stress coping in migraine patients, meditation experienced subjects, and healthy controls. 45 meditation experienced subjects, 46 migraine patients, and 46 healthy controls took part in the study. Cortical activity was measured with the contingent negative variation (CNV), a slow cortical event-related potential. Stress coping was examined with the standardized Stress Coping Questionnaire SVF-78. A one-way analysis of variance was used to investigate possible differences between the groups. CNV-amplitude was significantly higher in migraineurs than in controls. The meditators showed significantly lowest amplitudes. Migraine patients used negative stress-coping strategies significantly more often than meditators and healthy controls. Especially the application of the strategy “rumination” was most frequent in migraine patients and least frequent in meditators. Moreover, frequent rumination was significantly correlated with high CNV-amplitudes. Cortical and stress processing in people with meditation experience was improved compared to migraine patients and healthy controls.