Nonpharmologic Management:

Educating patients about headache and its management, identifying and managing triggers (via diaries), modifying lifestyles, and understanding the importance of adopting and adhering to interventions are relevant to all persons with headache.

Strong candidates for nonpharmacologic treatment include individuals with significant headache-related disability, comorbid mood or anxiety disorders, difficulty managing stress or other triggers, medication overuse, and patients who prefer a specific treatment [1].

Mind-body exercise and behavioural treatments (yoga, relaxation, biofeedback, and cognitive-behavioural therapy) possess the most evidence for successful headache management [1].

They have a long history of randomized trials showing efficacy and are considered first-line preventive options.

Yoga treatment has been shown to significantly reduce headache activity, reduce medication intake, symptoms and stress perception, and improve coping behaviour [2], [3].

Reducing medication usage is an important outcome for headache suffers, as frequent use of over the counter headache medication can result in an increase in headaches, a condition known as medication overuse headache [4], [5], [6]. Additionally, prolonged overuse of acetaminophen can cause liver damage, while overuse of nonsteroidal anti-inflammatory drugs can lead to gastrointestinal bleeding [7].

Adoption of a yoga based regime for management of chronic headache also has positive secondary outcomes. In a recent study, participants demonstrated improvements in perceived stress (P < .02), depression (P < .05), state and trait anxiety (P < .02 and .01), well-being (P < .01), physical well-being (P < .01), and vigor (P < .02).[8]

REFERENCES:

1. Nicholson, R. A., Buse, D. C., Andrasik, F., & Lipton, R. B. (2011). Nonpharmacologic treatments for migraine and tension-type headache: how to choose and when to use. Current treatment options in neurology, 13(1), 28-40.

2. Latha, D., & Kaliappan, K. V. (1992). Efficacy of yoga therapy in the management of headaches. Journal of Indian Psychology.

3. John, P. J., Sharma, N., Sharma, C. M., & Kankane, A. (2007). Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache: The Journal of Head and Face Pain, 47(5), 654-661.

4. Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache. 2008 Sep;48(8):1157–68.

5. Bigal ME, Lipton RB. Excessive acute migraine medication use and migraine progression. Neurology. 2008 Nov 25;71(22):1821–8.

6. Zwart JA, Dyb G, Hagen K, Svebak S, Holmen J. Analgesic use: a predictor of chronic pain and medication overuse headache – the Head-HUNT Study. Neurology. 2003;61:160–4.

7. Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;55:754–62.


8. Michalsen A, Grossman P, Acil A, et al Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit. 2005;11:CR555-561. Epub 2005 Nov 24