Biobehavioral treatments of migraine.

Donald B Penzien, Megan B Irby
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Abstract

Pharmacotherapies are the mainstays of migraine management, though it is not uncommon for them to be poorly tolerated, contraindicated, or only modestly effective. There is a clear need for nonpharmacologic migraine therapies, either employed alone or in combination with pharmacotherapies. Behavioral and psychosocial factors known to contribute to the onset, exacerbation, and persistence of primary headache disorders (e.g., stress, sleep, diet) serve as targets within a self-management model for migraine-a model that features headache pharmacotherapies, behavioral skills training, medication adherence facilitation, relevant lifestyle changes, and techniques to limit headache-related impairment. Behavioral self-management interventions for migraine with the strongest empirical validation (e.g., relaxation training, biofeedback training, cognitive-behavior therapies) presently are available in specialty headache treatment centers and routinely show promise for reducing headache pain frequency/severity and related impairment, reducing reliance on pharmacotherapies, enhancing personal control over headache activity, and reducing headache-related distress and symptoms. These approaches may be particularly well-suited among patients for whom pharmacotherapies are unwanted, poorly tolerated, or contraindicated. Though underutilized, clinical trials indicate that new and well-established behavioral therapies are similarly effective to migraine medications for migraine prevention among adults and can be successfully employed in various settings.

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偏头痛的生物行为疗法。
药物疗法是偏头痛治疗的主要手段,但耐受性差、禁忌或疗效不佳的情况并不少见。目前显然需要非药物性偏头痛疗法,既可以单独使用,也可以与药物疗法结合使用。行为和社会心理因素(如压力、睡眠、饮食等)已知会导致原发性头痛疾病的发作、加重和持续存在,因此可作为偏头痛自我管理模式的目标--该模式包括头痛药物治疗、行为技能培训、促进坚持服药、改变相关生活方式以及限制头痛相关损伤的技术。目前,头痛专科治疗中心可提供经验最丰富的偏头痛行为自我管理干预措施(如放松训练、生物反馈训练、认知行为疗法),这些干预措施在降低头痛疼痛频率/严重程度及相关损伤、减少对药物疗法的依赖、增强个人对头痛活动的控制以及减少头痛相关痛苦和症状等方面显示出良好的前景。这些方法可能特别适合那些不需要药物治疗、耐受性差或有禁忌症的患者。临床试验表明,在预防成人偏头痛方面,新的和成熟的行为疗法与偏头痛药物疗法具有相似的疗效,而且可以在各种情况下成功应用。
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来源期刊
Handbook of clinical neurology
Handbook of clinical neurology Medicine-Neurology (clinical)
CiteScore
4.10
自引率
0.00%
发文量
302
期刊介绍: The Handbook of Clinical Neurology (HCN) was originally conceived and edited by Pierre Vinken and George Bruyn as a prestigious, multivolume reference work that would cover all the disorders encountered by clinicians and researchers engaged in neurology and allied fields. The first series of the Handbook (Volumes 1-44) was published between 1968 and 1982 and was followed by a second series (Volumes 45-78), guided by the same editors, which concluded in 2002. By that time, the Handbook had come to represent one of the largest scientific works ever published. In 2002, Professors Michael J. Aminoff, François Boller, and Dick F. Swaab took on the responsibility of supervising the third (current) series, the first volumes of which published in 2003. They have designed this series to encompass both clinical neurology and also the basic and clinical neurosciences that are its underpinning. Given the enormity and complexity of the accumulating literature, it is almost impossible to keep abreast of developments in the field, thus providing the raison d''être for the series. The series will thus appeal to clinicians and investigators alike, providing to each an added dimension. Now, more than 140 volumes after it began, the Handbook of Clinical Neurology series has an unparalleled reputation for providing the latest information on fundamental research on the operation of the nervous system in health and disease, comprehensive clinical information on neurological and related disorders, and up-to-date treatment protocols.
期刊最新文献
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