Counseling For Headache Relief? Lifestyle Changes May Trump Medication

Headache relief
Medications and clinical tests are frequently prescribed for headache and migraine, despite clinical counseling shown to be an effective (and cheaper) solution. Aldo Cavini Benedetti/CC BY-NC-SA 2.0

Swapping tests for counseling could offset productivity loss due to headaches, according to a new study published in the Journal of General Internal Medicine.

Researchers from Beth Israel Deaconess Medical Center (BIDMC) in Boston cite more than 12 million Americans visit their doctors each year to complain of headache. Though the World Health Organization believes the number of people who have headache is underestimated, under-recognized, and under-treated throughout the world. The loss in productivity combined with health care costs totals over $31 billion — a number that may decrease if patients are counseled on lifestyle changes rather than ordered special tests.

The present research explores data collected from over 9,000 patients complaining of headache between the years 1999 and 2010 (or 144 million patient visits). Most physicians, researchers found, ordered high-cost tests, like advanced imaging; CT scans and MRIs increased from 6.7 percent of visits in 1999 to 13.9 percent in 2010. Physicians also frequently prescribed medication: Ibuprofen for migraine is steady at 16 percent of medications, while anti-migraine medications rose from 9.8 percent to 15.4 percent in the study’s 11-year period.

What’s interesting is clinical counseling decreased from 23.5 percent to 18.5 percent — an alarming trend if you ask Dr. John N. Mafi, lead study author a fellow in the Division of General Medicine and Primary Care at BIDMC.

"I was particularly alarmed about the overall trend of more imaging tests, medications, and referrals alongside less counseling," he said in a press release. "These findings seem to reflect a larger trend in the U.S. health care system beyond just headache: over-hurried doctors seem to be spending less time connecting with their patients and more time ordering tests and treatments.”

Clinical counseling for headache emphasizes the importance of stress reduction and a healthy diet, two known triggers of headache. Symptoms vary depending on the severity of the headache, but in addition to tests and medications, there are alternative therapies available to educate patients on “trigger-avoiding lifestyle changes.” The American Academy of Neurology adds stopping certain medications and maintaining a consistent sleep schedule, in addition to a weight loss program, can provide pain relief. Medical Daily, too, has reported on the natural remedies for migraine and headache.

Mafi believes we need to move toward promoting and reimbursing these lifestyle solutions, including the concept of doctors and patients working outside the office to control lifestyle triggers.

"The management of headache represents an area of particular concern for our healthcare system and stands out as an important opportunity to improve the value of health care in the U.S.,” Mafi said. An emphasis on tests may also reduce patient anxiety and invasive, follow-up procedures.

Whether it’s medication or counseling, getting a handle on frequent headache is important. Separate research suggests headache can damage your memory and ruin your sex drive.

Source: Mafi J.N., et al. Trends in the Ambulatory Management of Headache: Analysis of NAMCS and NHAMCS Data 1999–2010. Journal of General Internal Medicine. 2015.

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