Classification of Headache Disorders: Extending to a Multiaxial System

Martin, Paul R.

doi:10.1111/head.12966

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…Future headache diagnosis should take into account at least these psychosocial parameters, which are relevant for the selection of behavioral interventions. Martin (13) suggests a multiaxial system beyond categorical headache diagnosis by recommending an assessment of (a) disability, (b) trigger sensitivity and avoidance, and (c) other psychosocial parameters such as lifestyle or dysfunctional coping. Contrary to expectations, trigger sensitivity and avoidance (assessed by the HTSAQ) could not be identified as moderators between treatments in our study.…”

Section: Discussionmentioning

confidence: 99%

“…In the case of remarkable migraine-related disability and/or comorbid mental disorders, pain-specific behavioral therapy should be applied as an escalation of the standard behavioral approach (12). Beyond these recommendations, the empirical evidence for a differentiated indication or individual selection of behavioral treatments (“precision therapy”) in migraine should be advanced, particularly since clinical characteristics and treatment response in migraine patients are heterogeneous (11,13). Also, it is not yet clear whether a combination of several interventions is superior to single behavioral approaches.…”

Section: Introductionmentioning

confidence: 99%

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Behavioral treatment for migraine prophylaxis in adults: Moderator analysis of a randomized controlled trial

et al. 2023

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Background While growing evidence suggests the efficacy of various behavioral approaches to the preventive treatment of migraine, it remains largely unclear which behavioral interventions are indicated for which type of patient. This exploratory study aimed to identify moderators for the outcome between migraine-specific cognitive-behavioral therapy and relaxation training. Methods In this secondary analysis of an open-label randomized controlled trial, the data of N = 77 adults (completer sample) with migraine (mean age = 47.4, SD = 12.2, 88% female), who were allocated to either migraine-specific cognitive-behavioral therapy or relaxation training, was examined. Outcome was the frequency of headache days at the 12-month follow-up. We analyzed baseline demographic or clinical characteristics and headache-specific variables (disability, emotional distress, trigger sensitivity and avoidance, pain acceptance, self-efficacy) as candidate moderators. Results Higher headache-related disability (assessed via the Headache Impact Test, HIT-6, B = –0.41 [95% CI: –0.85 to –0.10], p = .047), higher anxiety (assessed via the subscale Anxiety of the Depression, Anxiety and Stress scales, DASS-A, B = –0.66 [95% CI: –1.27 to –0.02], p = .056), and the presence of a comorbid mental disorder ( B = –4.98, [95% CI: –9.42 to –0.29], p = .053), moderated the outcome in favor of migraine-specific cognitive-behavioral therapy. Conclusion Our findings contribute to an individualized treatment selection and suggest that preference for complex behavioral treatment (migraine-specific cognitive-behavioral therapy) should be given to patients with high headache-related disability, increased anxiety, or a comorbid mental disorder. Study Registration: Original study registered in the German Clinical Trials Register ( https://drks.de/search/de ; DRKS-ID: DRKS00011111).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Behavioral treatment for migraine prophylaxis in adults: Moderator analysis of a randomized controlled trial

et al. 2023

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“…A merely biomedical approach seems too restricted for managing both episodic CeH and TMD . An appropriate treatment should therefore be based on a biopsychosocial model .…”

Section: Discussionmentioning

confidence: 99%

Preclinical Signs of a Temporomandibular Disorder in Female Patients With Episodic Cervicogenic Headache Versus Asymptomatic Controls: A Cross‐Sectional Study

Mingels

Dankaerts

Granitzer

2019

PM&R

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Background: The International Classification of Headache Disorders, 3rd Edition, accepted "headache attributed to temporomandibular disorders" as a valid headache. The neurophysiologic interplay between cervical structures and the temporomandibular joint, however, might also suggest that a temporomandibular disorder could develop in patients with cervicogenic headache. Objective: To compare the presence of preclinical temporomandibular signs between female patients with episodic cervicogenic headache and a control group. Design: Case-controlled cross-sectional design. Setting: Institutional setting: Hasselt University. Participants: Twenty-two women (mean age AE SD: 20.7 AE 2.5 years) with episodic cervicogenic headache, without temporomandibular signs and 22 matched (gender, age, level of education, occupation) asymptomatic controls (21 AE 2.3 years). Methods: (Un)assisted temporomandibular range of motion, pressure pain thresholds, painful palpations were examined and the level of perceived stress was measured. Main Outcome Measurements: Temporomandibular range of motion (mm), pressure pain thresholds (kPa/cm²), painful palpations (yes/no), and level of perceived stress (Perceived Stress Scale). Results: Maximal mouth-opening was significantly smaller in the headache group (P <.05; effect size [ES] −0.45). Palpation of the masseter resulted in significantly more positive pain responses in the headache group at the left (P = .009; ES ∞) and right (P = .002;ES 17.5) origin, left (P = .004; ES 14.54) and right (P = .03; ES 5.71) body and left (P < .001; ES 12) insertion. Significantly lower pressure pain thresholds on the left and right anterior (P = .03; ES −0.33 resp. P = .02; ES −0.35), central (P = .003; ES 1.02 resp. P = .02; ES 0.79) and right posterior (P = .03; ES 0.62) temporalis and right tibialis anterior (P = .03; ES −0.33) were measured in the headache group. The level of perceived stress was significantly higher (P = .02) in the headache group. Conclusions: Patients with episodic cervicogenic headache present with signs of a preclinical temporomandibular disorder and sensitization. The smaller range of motion, lower pressure pain thresholds, and higher levels of stress accentuate the multidimensionality of the problem.

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“…It would also be helpful to include triggers in ICHD as an axis or via the use of codes, 87,88 as we move forward from ICHD‐3 to ICHD‐4 alpha 89 . This would encourage thorough assessment of triggers and incorporation of trigger management into treatment planning.…”

Section: Pathways Forwardmentioning

confidence: 99%

Triggers of Primary Headaches: Issues and Pathways Forward

Martin

2020

Headache

Self Cite

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The triggers of primary headaches have considerable significance for our understanding and management of headache and migraine. Triggers explain the variance in headaches – why they occur when they do. Trigger management is generally viewed as an important component of a comprehensive treatment approach for headaches. Historically, however, triggers have not had a prominent place in the headache literature. This situation began to change 20 to 30 years ago, and the pace of change has increased exponentially in recent times. Nevertheless, the field is beset with issues that have held it back from achieving more. This review will focus on elaborating those issues with the goal of suggesting ways forward. The first issue considered will be the definition of a trigger, and how specific triggers are labeled. Consideration will then be given to a classification system for triggers. The review will discuss next the evidence relating to whether self‐reported triggers can, indeed, precipitate headaches, and how the capacity to elicit headaches may be acquired or extinguished. Attention will be given to the very important clinical issue of trigger management. Finally, the pathways forward will be proposed. Perhaps the most useful thing to accomplish at this point in time would be agreement on a definition of headache triggers, a list of triggers, and a classification system for triggers. This would greatly assist in comparing research on triggers from different research groups as well as eliminating some of the issues identified in this review. An authoritative body such as the American Headache Society or the International Headache Society, could establish a multidisciplinary committee that would complete these tasks. Consideration should also be given to incorporating triggers into the International Classification of Headache Disorders as an axis or via the use of codes, as this would raise the profile of triggers in assessment and management.

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Classification of Headache Disorders: Extending to a Multiaxial System

Cited by 5 publications

References 17 publications

Behavioral treatment for migraine prophylaxis in adults: Moderator analysis of a randomized controlled trial

Behavioral treatment for migraine prophylaxis in adults: Moderator analysis of a randomized controlled trial

Preclinical Signs of a Temporomandibular Disorder in Female Patients With Episodic Cervicogenic Headache Versus Asymptomatic Controls: A Cross‐Sectional Study

Triggers of Primary Headaches: Issues and Pathways Forward

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