Underuse of Behavioral Treatments for Headache: a Narrative Review Examining Societal and Cultural Factors.
Underuse of Behavioral Treatments for Headache: a Narrative Review Examining Societal and Cultural Factors.
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DOI：
10.1007/s11606-020-06539-x
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发表时间：
2021-10
影响因子：
5.7
通讯作者：
Minen MT
中科院分区：
文献类型：
--
作者：
Langenbahn D;Matsuzawa Y;Lee YSC;Fraser F;Penzien DB;Simon NM;Lipton RB;Minen MT
偏头痛影响着4000多万美国人，是世界上第二大致残疾病。由于偏头痛的大部分医疗护理发生在初级保健环境中，而不是神经病学或头痛专科实践中，医疗保健系统干预应侧重于初级保健。虽然有A级证据表明行为疗法(如生物反馈、认知行为疗法(CBT)和放松技术)治疗偏头痛，但这些疗法没有得到充分利用。行为疗法可能是阿片类药物的有价值的替代方案，阿片类药物仍然广泛用于偏头痛，尽管美国阿片类药物流行，指南建议不要使用阿片类药物。识别和消除使用头痛行为疗法的障碍可以帮助减少偏头痛的残疾以及个人和社会成本。如果在初级保健环境中向偏头痛风险最大的社会经济地位较低的群体提供这些技术，将产生最大的影响。我们回顾了社会和文化挑战，这些挑战对非药物治疗服务的最佳使用构成了障碍。这些障碍包括：对偏头痛/头痛的行为治疗知识不足，提供非药物治疗培训的临床医生不足；在服务不足的社区获得的机会有限；财政负担；与头痛和精神健康诊断和治疗有关的耻辱。对于每一种障碍，我们讨论了将其影响最小化从而提高非药物治疗利用率的潜在方法。一名25岁的研究生，在大学里有头痛的病史，晚上一边上学一边做全职工作。现在，他的头痛有严重的恶心和畏光。他们每周两次，残疾程度足以让他无法完成家庭作业。他不明白为什么头痛会出现在周六，因为他整个星期都在努力完成周五晚上举行的考试。他尝试了两种不同的偏头痛预防药物，但都没有像他的医生希望的那样减少50%的头痛天数。他的医生曾建议他在开始服药之前接受认知行为疗法(CBT)，但他太忙了，没有时间参加预约，而且事实证明，寻找网络内提供者的挑战很难。现在，随着头痛的加剧，他选择了CBT，到了第五周，他已经注意到头痛的频率和强度有所改善。
Migraine affects over 40 million Americans and is the world’s second most disabling condition. As the majority of medical care for migraine occurs in primary care settings, not in neurology nor headache subspecialty practices, healthcare system interventions should focus on primary care. Though there is grade A evidence for behavioral treatment (e.g., biofeedback, cognitive behavioral therapy (CBT), and relaxation techniques) for migraine, these treatments are underutilized. Behavioral treatments may be a valuable alternative to opioids, which remain widely used for migraine, despite the US opioid epidemic and guidelines that recommend against them. Identifying and removing barriers to the use of headache behavioral therapy could help reduce the disability as well as the personal and social costs of migraine. These techniques will have their greatest impact if offered in primary care settings to the lower socioeconomic status groups at greatest risk for migraine. We review the societal and cultural challenges that impose barriers to optimal use of non-pharmacological treatment services. These barriers include insufficient knowledge of migraine/headache behavioral treatments and insufficient availability of clinicians trained in non-pharmacological treatment delivery; limited access in underserved communities; financial burden; and stigma associated with both headache and mental health diagnoses and treatment. For each barrier, we discuss potential approaches to minimizing its effect and thus enhancing non-pharmacological treatment utilization. Case Example A 25-year-old graduate student with a prior history of headaches in college is attending school in the evenings while working a full-time job. Now, his headaches have significant nausea and photophobia. They are twice weekly and are disabling enough that he is unable to complete homework assignments. He does not understand why the headaches occur on Saturdays when he pushes through all week to get through his examinations that take place on Friday evenings. He tried two different migraine preventive medications, but neither led to the 50% reduction in headache days his doctor had hoped for. His doctor had suggested cognitive behavioral therapy (CBT) before initiating the medications, but he had been too busy to attend the appointments, and the challenges in finding an in-network provider proved difficult. Now with the worsening headaches, he opted for the CBT and by the fifth week had already noted improvements in his headache frequency and intensity.
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DOI：
10.1016/s1474-4422(17)30299-5
发表时间：
2017-11
期刊：
The Lancet. Neurology
影响因子：
--
作者：
GBD 2015 Neurological Disorders Collaborator Group
通讯作者：
GBD 2015 Neurological Disorders Collaborator Group
影响因子：
3.3
作者：
Andrasik, F.
通讯作者：
Andrasik, F.
影响因子：
4.2
作者：
Berry, Kelsey N.;Huskamp, Haiden A.;Barry, Colleen L.
通讯作者：
Barry, Colleen L.
影响因子：
5
作者：
Burch, Rebecca C.;Loder, Stephen;Smitherman, Todd A.
通讯作者：
Smitherman, Todd A.
影响因子：
5
作者：
Ernst MM;O'Brien HL;Powers SW
通讯作者：
Powers SW