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Biomedical subjects

Frank Andrasik

Publications and source records attributed to Frank Andrasik.

17 recordsLinked to original sources
PubMed2006

Neurophysiological reactivity before a migraine attack.

Migraine patients are characterized by increased amplitudes and reduced habituation of the contingent negative variation (CNV) response, especially before a migraine attack. As shown previously, migraine provoking and precipitating agents can cause CNV abnormalities. However, it is unclear whether the temporal relation to the migraine attack determines how the brain reacts to a migraine precipitant. In this study, experimentally-induced achievement stress, one of the typical precipitants for migraine, was examined for its effects upon the CNV response. CNV was recorded during conditions of rest and stress, both before and after a migraine attack, as well as during a headache-free interval. The neurophysiological reactivity to stress in migraineurs was compared with those of healthy subjects. Before a migraine attack, migraine patients demonstrated significantly more pronounced neurophysiological reactivity to stress: the amplitude of the early CNV component was more increased and its habituation was more reduced in the stress condition, especially 1-3 days before an attack compared with changes of CNV amplitudes and habituation under stress obtained after an attack, during the headache-free interval, or in healthy controls. The study demonstrates that the brain of migraine patients is characterized by increased susceptibility to migraine provoking agents before an actual attack.

Adult↗
PubMed2006

Medication-overuse headache: description, treatment, and relapse prevention.

Medication-overuse headache (MOH) has increasingly become a focus within the field of headache. The biologic and physiopathologic origin for MOH likely resides in receptor physiology, but it also is probable that the initiation and sustaining dynamics of this pathologic condition involve several other factors. Not all patients with frequent headache eventually overuse their medications, but when it happens (the percentage is approximately 1%), the diagnosis of MOH is clinically important because patients rarely respond to preventive medications while overusing acute medications. Properly treating medication overuse and preventing relapse require recognition of the different factors that contribute to its development and perpetuation, including some behaviors and psychologic elements that are important in sustaining the overuse of medication. The problem regarding the diagnosis, the classification, and clinical aspects of MOH is reviewed in this article. The different therapeutic approaches, initial outcomes, and long-term durability of treatment also are discussed.

Headache Disorders, Secondary↗
PubMed2006

Behavioral assessment and treatment of pediatric headache.

Headaches are quite common in children and adolescents, and they appear to persist into adulthood in a sizable number of individuals. Assessment approaches (interview, pain diaries, and general and specific questionnaires) and behavioral treatment interventions (contingency management, relaxation, biofeedback, and cognitive behavior therapy) are reviewed, as is the evidence base for their use. The article concludes with practical suggestions for headache management.

Biofeedback, Psychology↗
PubMed2005

A self-administered behavioral intervention using tailored messages for migraine.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of a Self-Administered Behavioral Intervention using Tailored messages (SEABIT) for migraine. The primary measures were headache days, headache-related disability, behavioral/emotional factors, and headache-related beliefs. BACKGROUND: Behavioral and cognitive-behavioral interventions for migraine treatment are well established and possess "Grade-A" evidence based on the U.S. Headache Consortium evidence-based guidelines. To increase the accessibility of behavioral interventions in primary and other settings, treatment can be delivered in self-administered formats. Incorporating tailored health communication strategies (via tailored messages) into a self-administered format can help maintain a level of personalization without requiring regular visits to a behavioral specialist. Tailored messages are created using individual-level assessment data to educate and motivate the patient to develop behavioral skills and strategies for migraine prevention and management. METHODS: Twenty-five individuals (95% female, 90% Caucasian, mean headache years = 21.0) began and 84% (21/25) completed all phases of the 8-week SEABIT developed for migraine prevention (preceded by a 1-month baseline phase and followed by a 1-month postintervention phase). RESULTS: Overall, 62% (13/21) reported at least a 50% reduction in headache frequency, and mean headache frequency for the group was also significantly reduced from baseline to postintervention (16.9 vs. 10.7, P < .001; eta2= .61). Headache-related disability, behavioral/emotional factors, and headache-management self-efficacy also showed significant improvement. CONCLUSION: The findings suggest that the SEABIT for migraine prevention is an effective behavioral intervention that potentially could be accessed and distributed in a variety of settings including primary care.

Adult↗
PubMed2005

Outcome measurement in behavioral headache research: headache parameters and psychosocial outcomes.

The experience of pain is complex and includes multiple dimensions or aspects, such as sensory and affective (among others). Headache includes not only pain, but also associated symptoms that can further diversify the relevant dimensions. Subjective ratings of head pain, sampled daily, have come to be regarded as the "gold standard" in behavioral headache research. Primary measures of headache include the attack frequency or headache days per month. Secondary measures of headache may include headache activity/index, headache duration, peak headache severity, and/or frequency of severe headaches per month. Secondary measures of disability and quality of life include Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT), Headache Disability Inventory (HDI). Secondary nonheadache measures include medication consumption, psychiatric symptoms, stress and coping, treatment satisfaction and preference, side effects, and others. Researchers should include not only primary measures of headache, but also secondary measures, disability and quality of life, and nonheadache measures. All measures should be clearly defined and reported. A baseline period that is adequate for each measure needs inclusion and a minimum of 4 weeks is recommended for primary headache measures. Specific suggestions for future research directions are provided.

Behavior Therapy↗
PubMed2005

Methodological issues in clinical trials of drug and behavior therapies.

Trials that compare drug and behavior therapies or evaluate combination therapy raise special methodological issues. This article reviews these methodological issues and, where possible, offers guidelines for addressing them. Sources of bias in the selection and recruitment of participants and in the measurement of treatment outcomes are discussed. In addition, methodological problems presented by the differing structures of behavior and drug therapy, by confounding variables, such as allegiance effects, differential expectations and preferences for drug or behavior therapy, and differential adherence with drug or behavior therapy also are reviewed. Issues in the selection of appropriate control groups are also discussed.

Behavior Therapy↗
PubMed2005

Efficacy and effectiveness approaches in behavioral treatment trials.

The objective is to clarify the distinction between efficacy and effectiveness approaches and to discuss how these approaches can be used in a complementary way in the development, evaluation, and implementation of behavioral treatments for primary headache in various settings. Efficacy studies, with an emphasis on internal validity, are experiments that evaluate treatment response in an ideal, highly controlled research environment. Despite their methodological strengths, efficacy studies are limited in their ability to estimate the treatment effects that can be expected in clinical practice settings. Effectiveness studies, with an emphasis on external validity, are outcome studies with less controls that evaluate treatment response in settings more representative of clinical practice. Effectiveness studies, however, are limited in their ability to determine the causal link between treatment and response. Based on the four-phase model used in new drug development, a three-phase linear progression model is presented for behavioral treatment studies. This model provides for pilot testing, efficacy testing, and effectiveness testing of behavioral treatments so that there is appropriate evaluation from initial promise of a developing treatment to implementation and dissemination to various treatment delivery settings.

Behavior Therapy↗
PubMed2005

Methodological considerations in research with special populations: children and adolescents.

Headache occurs across the lifespan, but limited attention has been devoted to children and adolescents. This article discusses pertinent methodological considerations when conducting behavioral research with pediatric populations. Issues needing special consideration when working with children and adolescents involve ethics, sample characterization, headache diagnosis, treatment administration, and outcome measurement. Available literature is reviewed and specific recommendations are offered when possible.

Adolescent↗
PubMed2005

Guidelines for trials of behavioral treatments for recurrent headache, first edition: American Headache Society Behavioral Clinical Trials Workgroup.

Guidelines for design of clinical trials evaluating behavioral headache treatments were developed to facilitate production of quality research evaluating behavioral therapies for management of primary headache disorders. These guidelines were produced by a Workgroup of headache researchers under auspices of the American Headache Society. The guidelines are complementary to and modeled after guidelines for pharmacological trials published by the International Headache Society, but they address methodologic considerations unique to behavioral and other nonpharmacological treatments. Explicit guidelines for evaluating behavioral headache therapies are needed as the optimal methodology for behavioral (and other nonpharmacologic) trials necessarily differs from the preferred methodology for drug trials. In addition, trials comparing and integrating drug and behavioral therapies present methodological challenges not addressed by guidelines for pharmacologic research. These guidelines address patient selection, trial design for behavioral treatments and for comparisons across multiple treatment modalities (eg, behavioral vs pharmacologic), evaluation of results, and research ethics. Although developed specifically for behavioral therapies, the guidelines may apply to the design of clinical trials evaluating many forms of nonpharmacologic therapies for headache.

Behavior Therapy↗
PubMed2005

Biobehavioral treatment, disability, and psychological effects of pediatric headache.

Headache is a common condition among children and adolescents, and it can result in considerable pain, distress, and functional disability. Lacking proper care, many children will continue to experience headaches into adulthood. These considerations point to the importance of prompt, effective, and early intervention for pediatric headache. Biobehavioral treatments are central to such intervention. From promotion of adherence to optimal use of abortive and prophylactic medications to health behaviors that reduce headache activity to biofeedback-assisted relaxation training, the addition of biobehavioral treatment components to a comprehensive pediatric headache care plan can lead to better initial clinical outcomes, may lessen the need for medication, and may help maintain effects over the long term. Attention to the effects of headache and the accompanying psychological distress is an equally important part of treatment. Indeed, outcomes should be measured in terms of pain parameters (headache frequency, duration, severity) and effect on functional disability and quality of life (school absences, mood, satisfaction with pain relief). Optimal care for children and adolescents with headache can be realized with collaboration among primary care practitioners and headache specialists such as child neurologists and pediatric behavioral medicine experts. Biobehavioral treatment is a foundation for provision of such care.

Biofeedback, Psychology↗
PubMed2004

Behavioral treatment of migraine: current status and future directions.

The empirical support for three behavioral treatments (relaxation, biofeedback and cognitive therapy) for managing migraine headaches in children and adults is reviewed. Meta-analyses and evidence-based reports show that these approaches are of considerable value, they appear to work equally well when applied individually, in groups or in limited contact formats. Meta-analyses comparing behavioral and prophylactic medication show equivalent results. However, outcomes are optimized when these treatments are combined. Researchers are currently seeking to identify factors predictive of response to behavioral approaches. Patients experiencing medication-overuse, refractory, cluster or post-traumatic forms of headache or comorbid conditions present special challenges that can require intensive, comprehensive and multidisciplinary approaches to treatment. Behavioral treatments have met with mixed success for menstrual migraine in the few studies that have been conducted. This review concludes by highlighting directions for future research efforts such as importing treatments to settings where headache patients most often seek care and developing algorithms for optimizing combinations of behavioral and pharmacological treatments to enhance effectiveness, reduce costs, minimize dosing requirements and improve adherence to needed medications. Other research efforts include developing treatments that target the underlying pathophysiology more directly, gaining a greater understanding of mediators and moderators of behavioral treatments, exploiting e-technology for assessment and treatment, and assessing outcome in multiple ways--such as quality of life.

Behavior Therapy↗
PubMed2002

Behavioral management of recurrent headache: three decades of experience and empiricism.

In the past three decades, behavioral interventions (chiefly relaxation, biofeedback, and stress-management) have become standard components of the armamentarium for management of migraine and tension-type headaches. Meta-analytic literature reviews of these behavioral interventions have consistently identified clinically significant reductions in recurrent headache. Across studies, behavioral interventions have yielded approximately 35-50% reduction in migraine and tension-type headache activity. Although we have only recently begun to directly compare standard drug and nondrug treatments for headache, the available evidence suggests that the level of headache improvement with behavioral interventions may rival those obtained with widely used pharmacologic therapies in representative patient samples. In recent years, some attempts have been made to increase the availability and cost effectiveness of behavioral interventions through alternative delivery formats and mass communications. Recent developments within diagnosis and classification are summarized, pointing out implications for behavioral researchers. Select future directions are discussed, which include impact of the triptans, cost and cost effectiveness, and integration of behavioral treatments into primary care settings, the place where the great majority of headache sufferers receive treatment.

Biofeedback, Psychology↗
PubMed2002

Behavioral and pharmacologic treatment of transformed migraine with analgesic overuse: outcome at 3 years.

OBJECTIVE: To determine whether combined treatment using medication and biofeedback would be more effective than drug treatment alone for treating transformed migraine complicated by analgesic overuse. BACKGROUND: Headaches that are chronic, daily, and aggravated by medication overuse are particularly difficult to treat. METHODS: Sixty-one consecutive patients with transformed migraine and analgesic overuse were treated with inpatient pharmacologic therapy alone or with inpatient pharmacologic therapy combined with biofeedback-assisted relaxation. All patients then were followed prospectively for 3 years. RESULTS: Both treatment groups exhibited similar levels of improvement immediately following treatment and for 1 year thereafter. At year 3, participants receiving combined treatment showed greater sustained improvement on two of three outcome measures assessed (ie, fewer days of headache and reduced consumption of analgesic medication). In addition, a greater number of patients assigned to pharmacologic treatment alone relapsed (ie, resumed overuse of analgesics) compared to patients receiving combined treatment. CONCLUSIONS: These results suggest that a combination of pharmacologic and behavioral treatment is more effective than drug therapy alone in the long-term management of transformed migraine with analgesic overuse. Confirmation of these findings, as well as extension to other forms of behavioral and cognitive-behavioral treatment, is required.

Adult↗
PubMed1999

Psychophysiologic Therapy for Chronic Headache in Primary Care.

BACKGROUND: Headaches account for a high percentage of office visits to primary care physicians, with migraine and tension-type headaches the most common. This article provides a summary of psychophysiologic therapies for migraine and tension-type headache and considers psychosocial factors relevant to headache. Psychophysiologic therapy of headache consists primarily of relaxation and biofeedback. METHOD: Representative controlled studies, meta-analysis, and reviews are utilized to assess the efficacy of biofeedback and relaxation for migraine and tension-type headache. RESULTS: Psychophysiologic therapy comprising biofeedback and relaxation can be provided in standard or limited therapist contact formulas to patients as sole therapy or concurrently with medical therapy. Effectiveness has been demonstrated for thermal biofeedback-and electromyograph biofeedback-assisted relaxation with minimal or no side effects. A typical treatment protocol is offered to exemplify the integration of psychophysiologic therapy into primary care practice. CONCLUSION: Psychophysiologic therapy represents an important adjunctive treatment for chronic benign headache that can be incorporated into primary care.

Journal Article↗
PubMed1988

Psychological functioning of children who have recurrent migraine.

Thirty-two children experiencing recurrent migraine, aged 8-17, were compared to 32 non-headache peer controls matched for age, sex, and social class. Each child completed an extensive battery of psychological tests, which consisted of (1) the Children's Depression Inventory (for children aged 8-13) or the Beck Depression Inventory (for children 14 and above), (2) the State-Trait Anxiety Inventory for Children (ages 8-12) or the State-Trait Anxiety Inventory, Form X (ages 13 and above), (3) the Children's Depression Rating Scale, (4) the Personality Inventory for Children, (5) the Child Behavior Checklist, (6) the Psychosomatic Symptom Checklist, SUNYA Revision, (7) the Children's Social Readjustment Rating Questionnaire, (8) the Wide Range Achievement Test for Reading, and (9) the Peabody Picture Vocabulary Test, Form L. Children with migraine revealed higher scores on all scales measuring depression and somatic complaints; adolescent headache sufferers also revealed increased levels of trait anxiety. Older male headache sufferers revealed the poorest overall level of adjustment as reflected by scores on the Adjustment scale of the Personality Inventory for Children. It was argued that the psychological differences were most likely a consequence of the migraineurs having to live with frequent, unpredictable attacks of intense pain. However, the correlational nature of this study does not make it possible to rule out alternative explanations.

Adaptation, Psychological↗
PubMedDate not supplied

Disability in chronic migraine patients with medication overuse: treatment effects at 1-year follow-up.

OBJECTIVE: To determine (1) the clinical course of a sample of chronic migraine patients with drug overuse 6 and 12 months following in-patient treatment and (2) whether functional impairment, assessed by the Migraine Disability Assessment (MIDAS) questionnaire, improved upon treatment. BACKGROUND: Patients with chronic migraine and medication overuse are particularly difficult to treat (prophylactic medications that otherwise are effective become ineffective; discontinuation of the offending medication can lead to withdrawal headache; physical and emotional dependence can be present, as well as increased psychological involvement; initial treatment gains can be difficult to maintain). METHODS: Of the 106 patients meeting criteria for chronic migraine with medication overuse, 84 went on to complete a structured in-patient treatment, consisting of medication withdrawal and then prophylactic treatment. RESULTS: As a group, the patients were improved at both 6- and 12-month follow-up, with respect to two headache parameters (frequency and medication use) and three measures of functional impact extracted from the MIDAS questionnaire (Total Score, Headache Frequency, and Headache Intensity). CONCLUSION: Chronic migraine accompanied with medication overuse led to the considerable disability prior to treatment. However, notable improvement occurred coincident with the treatment. This suggests that successful treatment has more wide-ranging positive benefits beyond mere symptom reduction. To our knowledge, this is the first investigation where the MIDAS questionnaire has been used prospectively as an outcome measure in patients with chronic migraine and medication overuse to assess disability subsequent to a semi-standardized treatment program.

Adolescent↗