Mayumi Oakland
7/11/16
CAT#1
Acupuncture treatment reduces frequency of episodic migraine headaches
Clinical bottom line: Prophylactic acupuncture treatment decreases episodes of migraine
Clinical Scenario: Your patient is a 40 year-old Caucasian female visiting the clinic for migraine headache. She doesn’t want to take medication whenever migraine happens and asks if there anything else she can do to prevent or reduce the occurrence of headache.
Search Process: PubMed was searched with key wards “acupuncture” and “migraine”. Filters used were clinical trial, meta-analysis, systematic reviews, and publication dates within 5 years.
Chosen Article: Linde, K, A. Gianni, B. Brinkhaus, Y. Fei, M. Mehring, E. a. Vertosick, A. Vickers, and A. R. White. 2016 Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev 6:CD001218
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The World Health Organization Clinical Trials Registry Platform and clinicaltrial.gov were used to search for ongoing or unpublished data. Total number of adult participants were 4985. Two reviewers performed data extraction and assessment of risk of bias and intervention quality. The disagreements were settled by discussion.
Strengths: The primary and secondary outcome measures were clearly defined and reasonable. Only RCTs were included in the study and were searched thoroughly. Unpublished trials were included. Inclusion criteria of at least 6 treatment sessions (once a week) was very specific. In addition, study only included participants who had headache more than 12 months. Grading of Recommendations Assessment, Development and Evaluation was used to rate the study quality. Heterogeneity was assessed using Chi2 test and I2
Migraine headaches are the third most prevalent illness in the world, and ranked as the sixth most disabling illness. Statistics show that only about fifty percent of people who suffer from chronic headaches know that they’re suffering from a migraine. 76% of people who suffer from migraines worry that they will suffer for the rest of their lives, and 37% of sufferers worried about their migraines between attacks. Studies found that approximately 12% of Americans suffer from migraines, and 40% of Americans could benefit from preventative therapies. Even though studies show that at least 40% of sufferers could benefit from preventative therapies, only one in five sufferers are currently using preventative therapies. Studies also show that over 25% of people who suffer from migraine attacks miss at least one working day over the past three months, and nine out of ten sufferers say that they cannot “function normally” during those days. At least 98 percent of migraine attack sufferers take medications for temporary headache relief, whether it be over the counter or prescription. Only 12% of sufferers take preventative medications as opposed to the 98% of sufferers taking medications for relief. Severe migraines are ranked in the highest of seven disability classes, along with psychosis, dementia, and quadriplegia, published by the World Health Organization. People who participated in a survey who admitted to a
suffer from Migraines usually experience pain on one side of their head. There are several
Migraine headaches. We did talk about options. She was very interested in stopping amitriptyline. I elected to have her taper to a 10 mg dose. She was written for nortriptyline 10 mg one p.o. nightly #30 with two refills. If after a month or six weeks or so, she is feeling well from that standpoint, we could consider tapering off. She is going to monitor the amount of headaches, and how she is feeling overall with switch. She will call me if she has any problems or concerns with that.
she is able to identify the initiation of Migraine and take Sumatriptan, Naproxen, before symptoms worsen, and her pain level is controlled at a scale of 3/10; 2. she will take Metochlopromide at the onset of Migraine, and will report that the Migraine does not affect her oral intake; 3. she reports her photophobia stay the same but since headache improved, she does not need to bed rest; 4. she is able to provide a complete Migraine calendar with all information provided in details; 5. she is able to name at least 2 aggravating factors that will increase her Migraine; 6. she is able to list the food items that are not healthy (from her food intake diary) and identify the healthy alternatives; 7. she is able to have at least 5-6 hours of continuous sleep on a daily bases; 8. she will only work Friday and Saturday from 2100-0200 when an assignment or exam is in section; 9. she will report a regular attendance on Yoga class, and name at least 2 relaxation technique that is effective for her; 10. she will ask questions and expresses her concerns on the
The most recently released 2015 National Health Interview Survey (NHIS) was used in this study to analyze the racial differences in migraine prevalence among adults (age ≥ 18 years) in the United States. Data from 2010 to 2014 were also extracted to assess the annual trend of age and sex adjusted prevalence of migraine in the adult population.
If it is genetic then there is no prevention of migraine. It is passed on genetically just like eye colors, hair colors, skin colors, etc.
Excellent POST! Your detailed patient symptoms clearly outline a moderate migraine clinical presentation. Each patient presents differently is also a key to recognizing how to positively treat to meet individual factors (allergies, drug interactions, pregnancy concerns, age ect). For example, Woo and Robinson (2016) identify serotonin syndrome developments with interactions with triptans (p. 1043). Reviewing each patient’s medication list comprehensively is imperative and utilizing resources such as a pharmacist, can positively prevent potential detrimental events.
There are many people worldwide who suffer from migraine disorders. Any episodic migraine if not treated properly can lead to chronic Migraine, which is more than 15 migraine headaches per month. To prevent this condition and help patients to manage their migraine headaches, neurologists suggest cognitive behavioral therapy along with pharmaceutical treatments. To assess the efficacy of non-drug behavioral intervention in treatment and prevention of CM, a qualitative study can be established on a focused group of people. Those who have established Migraines diagnosis, who have shown limited benefits from medication or have intolerant side effects to pharmaceutical therapy will be in a semi structured guided interview for this study. The chosen
Migraine headaches are often experienced on one side of the head (Tepper, 2004). The pain is associated with the pulsatile sensation that differs from one person to another. Migraine is also characterized by throbbing and pounding headache that can lead to nausea, vomiting, and in some instances photophobia. Presently, about 12 % of Americans experience migraine headaches every day. Research shows that migraine mostly affect people aged 15 to 55 years (Tepper, 2004). Migraine has been said to occur as a result of impaired nervous and circulatory system. In migraine, blood vessels undergo vasodilation. The enlargement of the vessels interferes with the nerve cells that normally surround the vessels making them secrete various chemical mediators. These chemicals include prostaglandins, substance P, interleukins, and cytokines (Schulman, 2010). The chemicals are responsible for inflammation and transmission of pain impulses. The associated feelings of nausea and vomiting are attributed to the activation of the sympathetic nervous system. The sympathetic response also leads to slowed motility and gastric emptying that in turn reduces absorptions of gastric contents such as nutrients and drugs. Additionally, the sympathetic system also leads to excessive sound and light sensitivity. Statistics reveals that migraines affect more women than men. The severity of migraine headaches ranges from mild, moderate to severe depending on the individuals affected. In some instances, migraine headache can be a major cause of morbidity due to its debilitating
Each year over twenty-six million people nation wide are affected by migraines. Once thought to be a concentration of evil spirits in the brain, common cures consisted of everything from drilling holes in the skull, to inserting garlic cloves into the temples. Today however, scientists realize that this all too common occurrence is actually a neurological disorder, which can result in the disability of its victim for hours or even days. I myself have been a constant sufferer of migraines since the age of twelve. The following is the life of a migraine sufferer: myself.
Acute treatment aims to reverse, or at least stop, the progression of a headache that has started. Preventive treatment, which is given even in the absence of a headache, aims to reduce the frequency and severity of the migraine attack, make acute attacks more responsive to abortive therapy, and perhaps also improve the patient's quality of life. An overview of migraine treatment is shown in the image
Comparing the results of migraine attacks of those that were given the acupuncture treatment (1.2677 < mean < (1.5323) to those given the sham treatment (2.6953 < mean < 2. 9047). We can automatically see that the migraine attacks in those given the acupuncture decreased in almost half compare to those that were not given any treatment, so we can conclude that the acupuncture treatment was very effective in treating
Headaches are worldwide prevalent, ubiquitous and disabling but still underdiagnosed, underrated and under-recognized. Even though regional differences are seen in headache prevalence all races, all ages and all income levels are affected (Steiner, T.J. 2013). Both primary and secondary headaches have a major impact on individuals and society. This assembles with high financial costs, either direct (healthcare costs) or indirect (decrease in work productivity) (Manzoni et al. 2010). Tension-type headache (TTH) is the most common primary headache. Stovner and Colette (2010) studied the prevalence of migraine, TTH, cluster headache and medication overuse headache in Europe. Overall, the current prevalence of TTH among adults was 62,6%. Chronic TTH (CTTH) occurred in 3,3%. Antilla (2006) described the TTH prevalence among adolescents, ranging from 10% (Sweden) to 73% (Brazil), found in different population-based studies. Secondary headaches such as cervicogenic headache (CEH) showed a smaller prevalence (4,1%) as discussed by Sjaastad and Bakketeig (2008). Women showed a significant higher prevalence of TTH than men. This was less obvious for women with CEH. The forward head posture (FHP) plays an important role in both CEH and TTH. Fernandez-de-las-Penas et al. (2007) found that the FHP in CTTH was greater in stand but not in sitting position compared with control subjects. This differs from episodic TTH (ETTH) in which in both sitting and standing position a greater FHP was
The article utilized Cochrane Central Register of Controlled Trials, MEDLINE, and Scopus bibliographic databases that were not limited to just English studies. Also, Del Fabbro et al.
Results: 504 patients (378 females, 126 males) with migrainous chronic daily headache underwent the study. Dramatic, significant, moderate and mild or no improvement constituted 28.6%, 33.3%, 23.8%, and 14.3% of the post treatment courses respectively. Therapeutic effect of intervention on mean pain scores was significant; t=7.38, df=20, p=.000. Two cases developed subcutaneous fat atrophy in frontal injection site and 3 cases experienced syncope during injection.