Multidisciplinary Migraine Management
Recently, there was a great article published about migraine and its multiple sub-types (such as cluster headache, tension headache, etc) in “PAIN MEDICINE NEWS” medical journal. Migraine is a very common and notoriously difficult to treat neurological condition that affects about 12% of US population. The article goes into great length describing so-called “biopsychological model” of headaches and what causes them. It highlights the need for truly multidisciplinary approach to headache medical management. It talks about several successful government-run medical programs in different European countries such as Germany. It contrasts it with United States’ healthcare ways of managing this medical condition. Pharmacological/ medication treatments are discussed at length as well as the role of Interventional Medicine in headache management.
Usually, by the time the patient even ends up seeing a primary care physician, he or she has already tried multiple over the counter (OTC) medications such as Motrin, Tylenol, aspirin and caffeine. Once those medications have failed, patient is sent to a migraine specialist, usually a neurologist who frequently puts the patient on different medication combinations (antidepressants, anti-nausea, preventive, anti-seizure and even anti-hypertensive medications). However, abortive, instant action medications from so called “triptans” group are a main pillar of the med management.
However, in extremely difficult to treat cases, when everything else fails, the patient is referred to an interventional pain management doctor. Pain doctor has a wide variety of different tools at his or her disposal. They vary from simple trigger point injections in the neck area, to Botox injections, to occipital nerve blocks, to cervical area neuro-modulation implants, etc.
The last but not least are non-medication treatment modalities. Those include biofeedback, relaxation techniques, yoga, stress management, physical therapy, neck area massage, etc.
The conclusion of the article was as follows: “A tailored multidisciplinary approach to migraine management benefits everyone involved. Patients will have better outcomes for migraine, associated disability, complicating factors, and comorbidities. This strategy also leads to improved adherence by patients and improved satisfaction for patients”.