Identification and reduction of headache of headache triggers is an excellent long term headache prevention strategy. At the 2005 annual American Headache Society Conference, Leslie Kerman, MD reported that about three quarter of migraine headache patients experience triggers for migraine attacks The most common triggers are stress, hormones (in women), skipping meals and sleep disturbance. Comment: All our patients are given a headache diary and careful instructions to help identify and then decrease headache triggers.

Another research study on the multidisciplinary approach to migraine management has found substantial improvement in headache frequency and severity even five years after treatment. This study of pediatric migraine found that approximately 90% of patients who received medication management along with biofeedback, education and lifestyle changes showed continued improvement one and five years after treatment. (Headache 2005; 45,1296-303). Comment: The treatment program is very similar to the one at our clinic. This study is unusual because follow-up was at one and five year time intervals.

A review of over 100 behavioral migraine and tension headache treatment studies finds 35-55% improvement over controls. Muscle biofeedback combined with relaxation training along with cognitive therapy was found to have equal effectiveness to several preventive medications. Numerous professional organizations such as American Academy of Neurology and the American Medical Organization now endorse behavioral intervention for recurrent headache (Headache. 2005;45:S92-S108).

Nearly half of all primary care depressed patients also had migraines. (Ruoff, GE, American Academy of Family Physicians Conference, Sept, 2005). Comment: Migraine is often accompanied by co-morbid disorders such as irritable bowel syndrome, fibromyalgia, anxiety and depression. Treating the co-existing disorders is essential for effective headache management.