Fran Lowry

October 01, 2013

ORLANDO, Florida — Chronic tension-type headache (CTTH), which may affect up to 20% of teens, can be successfully treated without pharmacologic agents, a new study shows.

A retrospective review of 83 adolescents diagnosed with CTTH found that osteopathic manipulation and instruction in daily mindfulness and the traditional Chinese practice of qi gong was more effective than pharmacologic therapy in relieving their headaches.

"There is nothing in the literature for these kids, who often end up on chronic opioids," lead author Peter Przekop, DO, PhD, from the Betty Ford Center, Rancho Mirage, and Loma Linda University School of Medicine, Loma Linda, California, told Medscape Medical News.

The results were presented here at the American Academy of Pain Management (AAPM) 24th Annual Clinical Meeting.

"I wanted to figure out some way to help them because I see about 60 to 80 teens with this condition a year, and they are miserable. They are not doing well in school, they are not doing well in life. I don't want them on medications, which is always a problem in kids because the brain is changing and developing until 22 to 24 years in females and age 26 in males. Centrally acting medications can affect this development," Dr. Przekop said.

To compare the efficacy of pharmacologic vs nonpharmacologic treatment in teens with CTTH, Dr. Przekop and his team reviewed the charts of 83 adolescents (67 girls and 16 boys) who presented to their outpatient clinic for headache management between 2009 and 2013. Their average age was 15.7 years (range, 13 to 18 years).

Dr. Peter Przekop

There were 2 treatment groups. Group 1 (n = 44 patients) received amitriptyline or gabapentin as daily preventive medication. Group 2 (n = 39 patients) received bimonthly osteopathic manipulation and instruction in daily mindfulness and internal qi gong.

"Qi gong is a traditional Chinese practice that aligns breathing, slow, repeated movements and awareness to promote healing," Dr. Przekop explained. "The instruction on how to do mindfulness involves telling the patients to close their eyes, get in touch with what they were feeling inside, breathe, and stop the story going on in their head, to stop the story."

The teens in the experimental group were taught an internal qi gong routine that consisted of 6 simple moves that they practiced each day.

Both groups were assessed at study entry, 3 months, and 6 months to see whether the number and intensity of their headaches changed and whether the intervention affected their general health and quality of life.

Both groups improved, but the improvement was much more dramatic in the group that did qi gong and practiced mindfulness, Dr. Przekop said.

The nonpharmacologic intervention produced better results in headache frequency, headache pain intensity, general health, social activity, and number of tender points in the trapezius, cervical spine, and superior occipital notch than did pharmacologic treatment (P = .001 for all 5 measures).

Over the 6-month period, headache frequency decreased from 23.9 to 16.4 in the pharmacologic treatment group and from 22.3 to 4.9 in the nonpharmacologic group.

"Their perception of their general health improved, and most of these kids actually did quite well," Dr. Przekop said.

"If you meet these kids, they're not doing well in school, they don't have friends, they're staying home, they don't feel good about themselves. That's the thing I wanted to change, and that actually improved," he pointed out. "I think they were able to cope with their overall pain and overall stress and change the way they perceived the world and how they perceived themselves.

"Most pain has a cognitive component, which is how you perceive the world, how you perceive yourself, how you perceive life, and it has an emotional component where these children can't handle negative emotions. That's the thing that really changes with this treatment," he said.

One potential problem is that insurance often will not pay for nonpharmacologic treatment, Dr. Przekop noted.

"These groups were divided pretty much by what insurance would pay. All insurance plans will pay for amitriptyline and gabapentin; few insurances will pay for the other. Some of the kids actually heard that the kids on the nonpharmacologic treatment were improving, and the parents then came and paid cash. It's sad, but that's the state of affairs that we're in now."

Teens Want Control of Their Lives

Gerard J. Hevern, MD, from New Hampshire's Hospital for Children in Allenstown, New Hampshire, commented on this study for Medscape Medical News.

Dr. Gerard J. Hevern

"I've never seen anything quite like this before, and I think it makes some sense, because when pediatric patients come in they are looking for ways to maintain control of their lives without the use of medications, and if you create the opportunity, many of them will grab on to it," Dr. Hevern, who is also a practitioner at Elliot Pain Management Center in Manchester, New Hampshire, said.

"Also, the parents are very concerned about beginning their children on these medications, especially over the long run, so this is a great opportunity to begin to say that these nonpharmacological things actually do work as good, if not better than medications," he said.

Dr. Przekop and Dr. Hevern have disclosed no relevant financial relationships.

American Academy of Pain Management (AAPM) 24th Annual Clinical Meeting. Abstract #25. Presented September 27, 2013.


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