Efficacy and Feasibility of Behavioral Treatments for Migraine, Headache, and Pain in the Acute Care Setting
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PSYCHOLOGICAL AND BEHAVIORAL ASPECTS OF HEADACHE WITH PAIN (D BUSE, SECTION EDITOR)
Efficacy and Feasibility of Behavioral Treatments for Migraine, Headache, and Pain in the Acute Care Setting Daniel Vekhter 1 & Matthew S. Robbins 2 & Mia Minen 3 & Dawn C. Buse 4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This narrative review examines the use of behavioral interventions for acute treatment of headache and pain in the emergency department (ED)/urgent care (UC) and inpatient settings. Recent Findings Behavioral interventions demonstrate reductions of pain and associated disability in headache, migraine, and other conditions in the outpatient setting. Behavioral treatments may be a useful addition for patients presenting with acute pain to hospitals and emergency departments. Summary We review challenges and limitations and offer suggestions for implementation of behavioral interventions in the acute setting. Some evidence exists for relaxation-based treatments, mindfulness-based treatments, hypnosis/self-hypnosis, and immersive virtual reality for acute pain, migraine, and headache. There are few high-quality studies on behavioral treatments in the inpatient and emergency department settings. Further research is warranted to determine the efficacy and cost-effectiveness of these interventions. Given the general safety and cost-effectiveness of behavioral interventions, healthcare professionals may want to include these therapies in treatment plans. Keywords Pain management . Non-pharmacologic . Behavioral . Cognitive behavioral therapy . Relaxation training . Biofeedback . Mindfulness
Abbreviations MBSR Mindfulness-based stress reduction MBCT Mindfulness-based cognitive therapy ACT Acceptance and commitment therapy CBT Cognitive behavioral therapy This article is part of the Topical Collection on Psychological and Behavioral Aspects of Headache with Pain * Mia Minen [email protected] 1
Department of Neurology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ, USA
2
Department of Neurology, Weill Cornell Medicine, New York, NY, USA
3
NYU Langone Department of Neurology, New York, NY, USA
4
Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
Introduction Acute pain, headache, and migraine are common reasons for presentations to emergency departments and for admissions to the hospital [1]. Medications and injection-based therapies are frequently used for acute pain management. Many of these therapeutics, while effective, carry risks of adverse events [2]. In addition, the overuse of opiates has led to a nationwide epidemic of abuse, misuse, and dependence in the USA [3]. Behavioral interventions are not a standard part of inpatient or emergency department (ED)/urgent care (UC) for migraine, headache, or pain treatment [2]. Nonetheless, the safety and efficacy of many behavioral treatments for pain and headache has been demonstrated convincingly in the outpatient setting [4]. This review discusses
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