Complementary and Integrative Approaches for Pediatric Headache
Introduction
Complementary alternative medicine (CAM) use is common in the US population and in children with neurological disease.1, 2, 3 Although CAM use is widespread, research in this field and evidence-based recommendations are trailing behind. This leaves medical providers uneasy in counseling patients and their families on CAM-related treatments. Similarly, patients and the families are uneasy in disclosing CAM use to their medical providers, despite wanting advice on complementary therapies.4, 5, 6
The objective of this review is to paint the landscape of CAM for the management of pediatric headache using an integrative approach. This is in line with the recent name change of the NIH National Center for CAM (NCCAM) to National Center for Complementary and Integrative Health (NCCIH). This provides attention and focus on the “integrative” rather than “alternative” approaches. Several recent publications review the scant evidence for complementary therapies for pediatric and adult headache.7, 8, 9, 10 This article is aimed to expand on these reviews and empower medical providers with background information and knowledge around complementary and integrative approaches for pediatric headache populations.
Section snippets
An Integrative Approach
Integrative medicine focuses on treating the whole person, integrating conventional medicine with mind-body-spirit methods. An integrative approach for pediatric headache can be categorized using a mind-body-spirit framework as well. Providing a comprehensive integrative approach is frequently lost in day-to-day medical practice given the focus on conventional approaches with “sound” medical evidence, limits in time, and lack of knowledge in integrative methods. However tools and knowledge for
Mind
Approaches centered on the mental aspect of a person have 3 primary goals: stress management, pain coping, and behavioral change. A focused review of the behavioral approaches including cognitive behavioral therapy in pediatric migraine has recently been published by Kroner el al12 Here we focus on concepts of mindfulness, promoting self-awareness, as well as biofeedback and neurofeedback.
Mindfulness
Mindfulness is being present at the moment with openness and nonjudgement; it is a state of full awareness that does not exclude anything. This can sometimes be confused with heightened concentration, which limits your perception of something to a single focal point. Being mindful, is being present with a consciousness of both internal and external milieus, including emotions, thoughts, and sensations.
Mindfulness based stress reduction (MBSR) program is an 8-week program created by Jon
Self-Awareness
Self-awareness by definition is the ability to consciously process information about ourselves in a manner that reflects a relatively objective view while maintaining our unique subjective sense of self.18 Individuals with headaches have low self-awareness of their headache type and commonly mislabel their headaches.19, 20 Lack of awareness of headache types and therefore etiology of headaches leads to delayed and inappropriate treatment. In children with headaches, education and knowledge as
Biofeedback or Neurofeedback
Defined by the Biofeedback Certification International Alliance (BCIA), Association for Applied Psychophysiology and Biofeedback (AAPB), and International Society for Neurofeedback and Research (ISNR), biofeedback is21
… a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. These
Nutriceuticals
Nutriceuticals represent the class of complementary therapies that include dietary supplements in the form of vitamins and minerals. A thorough appraisal of the nutriceutical literature in pediatric headache reviewed magnesium, coenzyme Q10 (CoQ10), butterbur, ginkgolide B, and polyunsaturated fatty acids.7 A brief review of magnesium, CoQ10, and butterbur are presented here along with a review of vitamin D and melatonin.
Magnesium is involved in numerous enzyme reactions and important for
Spirit
Health care has made large efforts in recent years toward understanding illness in the context of the person—the individual. Efforts include the Patient-Centered Outcomes Research Institute (PCORI) and person-centered medicine initiatives for treating the whole person, mind-body-spirit. In the 2014 Gallup poll,77 86% of American adults reported a belief in God or a Universal Spirit. Up to 94% of patients would like their physicians to address spiritual issues.78, 79 However, spirituality is
Conclusions
Medical practitioners caring for pediatric patients with headaches should be informed of the variety of complementary and integrative practices for the treatment of pain and headaches. Despite limited numbers of studies for pediatric headaches, children and families seek these services. Primary care providers, neurologists, and headache specialists alike need to be informed of such interventions and integrate these approaches, when appropriate, in the management of children with headaches (case
References (91)
- et al.
Disclosure of CAM use to medical practitioners: A review of qualitative and quantitative studies
Complement Ther Med
(2004) - et al.
Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice
J Psychosom Res
(2010) - et al.
Efficacy of biofeedback for migraine: A meta-analysis
Pain
(2007) - et al.
Low heart rate variability and sudden cardiac death
J Electrocardiol
(1988) High heart rate variability, marker of healthy longevity
Am J Cardiol
(2010)- et al.
Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia
J Am Acad Child Adolesc Psychiatry
(2006) - et al.
A phase I study on the feasibility and acceptability of an acupuncture/hypnosis intervention for chronic pediatric pain
J Pain Symptom Manage
(2002) - et al.
Laser acupuncture in children with headache: A double-blind, randomized, bicenter, placebo-controlled trial
Pain
(2008) - et al.
Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: A randomised, double-blind, parallel-group, sham-controlled trial
Lancet Neurol
(2010) From the gate to the neuromatrix
Pain
(1999)
Complementary and alternative medicine use among adults with migraines/severe headaches
Headache
Patterns of complementary and alternative medicine use in children with common neurological conditions
Glob Adv Health Med
Complementary and alternative medicine (CAM) use in an Italian cohort of pediatric headache patients: The tip of the iceberg
Neurol Sci
Alternative headache treatments: Nutraceuticals, behavioral and physical yreatments
Headache
Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey
Ann Intern Med
Nutraceuticals in the prophylaxis of pediatric migraine: Evidence-based review and recommendations
Cephalalgia
Complementary and alternative medicine use for headache and migraine: A critical review of the literature
Headache
Headache in children: Update on complementary treatments
Neuropediatrics
Nonmedication, alternative, and complementary treatments for migraine
Continuum (Minneapolis, Minn)
Behavioral treatment of headaches: extending the reach
Neurol Sci
Cognitive Behavioral Therapy plus Amitriptyline for Children and Adolescents with Chronic Migraine Reduces Headache Days to ≤4 Per Month
Headache
How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress
J Clin Psychol
Brief mindfulness-based therapy for chronic tension-type headache: A randomized controlled pilot study
Behav Cogn Psychother
Effect of mindfulness-based stress reduction on pain severity and mindful awareness in patients with tension headache: A randomized controlled clinical trial
Nurs Midwifery Stud
Meditation for migraines: Pilot randomized controlled trial
Headache
The problem of impaired self-awareness in neuropsychological rehabilitation
Self-awareness of migraine: Interpreting the labels that headache sufferers apply to their headaches
Neurology
Low rate of self-awareness and medical recognition of migraine in Germany
Cephalalgia
The Behavior of Organisms: An Experimental Analysis
Getting Started with Neurofeedback
Biofeedback treatment for pediatric migraine: Prediction of treatment outcome
J Consult Clin Psychol
Psychological treatment of recurrent headache in children and adolescents—A meta-analysis
Cephalalgia
Biofeedback therapy for pediatric headache: Factors associated with response
Headache
Biofeedback in the treatment of headache and other childhood pain
Appl Psychophysiol Biofeedback
Is there ore to blood volume pulse than heart rate variability, respiratory sinus arrhythmia, and cardiorespiratory synchrony?
Biofeedback
Heart rate variability, prefrontal neural function, and cognitive performance: The neurovisceral integration perspective on self-regulation, adaptation, and health
Ann Behav Med
Heart rate variability: Standards of measurement, physiological interpretation and clinical use
Circulation
A healthy heart is not a metronome: An integrative review of the heart׳s anatomy and heart rate variability
Front Psychol
Heart rate variability: New perspectives on physiological mechanisms, assessment of self-regulatory capacity, and health risk
Glob Adv Health Med
Cardiac coherence, self-regulation, autonomic stability, and psychosocial well-being
Front Psychol
Nutraceuticals and headache: the biological basis
Headache
Visual evoked potentials and serum magnesium levels in juvenile migraine patients
Headache
Serum and salivary magnesium levels in migraine. Results in a group of juvenile patients
Headache
Deficit of brain and skeletal muscle bioenergetics and low brain magnesium in juvenile migraine: An in vivo 31P magnetic resonance spectroscopy interictal study
Pediatr Res
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The association of serum vitamin D concentrations in paediatric migraine
2023, European Journal of Paediatric NeurologyEffectiveness of complementary and alternative medicine interventions for sleep quality in adult intensive care patients: A systematic review
2020, International Journal of Nursing StudiesCitation Excerpt :Sleep OR sleep quality OR insomnia OR length of stay OR delirium. Melatonin as a search term for this review was predicated on this being considered a complementary and alternative medicine in many research studies on sleep or other conditions (for example, Gooneratne 2008; Hendren 2013; Kedia 2016). As Gooneratne (2008, p.125) argues, “Melatonin is one of the most thoroughly studied CAM biological compounds used for sleep”, and Clarke et al. (2015) in their national estimates on the use of complementary health approaches in the United States included melatonin in their survey of 88,962 adults (combined sample over three time points) and found its use more than doubled from 2007 to 2012.
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2018, Advances in PediatricsCitation Excerpt :The use of the magnesium salts glycinate, aspartate, gluconate, citrate, or malate will yield better results without causing diarrhea. Dosing ranges are 100 to 400 mg/d or 9 mg/kg/d [14]. Coenzyme Q-10 and riboflavin (vitamin B2) are two of the supplements that are purported to improve mitochondrial oxidative metabolism, which may, in theory, decrease the threshold for migraine attacks [15].
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