Interdisciplinary treatment including cognitive behavioral therapy and mindfulness for chronic migraine and drug-induced headache

Abstract

The presented clinical case describes the management of a patient with chronic migraine (CM), drug-induced headache (LIH), and generalized anxiety disorder. It shows the influence of genetic factors (hereditary predisposition to the development of addiction, anxiety disorder), biological factors (migraine attacks from adolescence, overuse of painkillers), psychological factors (stress, development of generalized anxiety disorder, pain catastrophizing), social factors (lack of rational supportive family environment) on the clinical picture of CM.A modern, evidence-based approach to the preparation of a treatment plan for a patient with CM and concomitant LIH and generalized anxiety disorder has been demonstrated. The interdisciplinary plan was developed and successfully applied for the treatment of the patient. It included withdrawal of painkillers, due to which LIH developed, symptomatic pharmacotherapy for the withdrawal period, an alternative drug for the relief of headache with a limited number of doses and dosage frequency allowed to the patient, prophylactic pharmacotherapy for CM, pharmacotherapy for the concomitant generalized anxiety disorder, and psychological methods such as cognitive behavioural therapy (CBT) and mindfulness. Recent studies showed that mindfulness helps patients with LIH successfully overcome the period of painkiller withdrawal, the effectiveness of mindfulness is  comparable to the effectiveness of preventive pharmacotherapy during the period of pain killer withdrawal. Mindfulness therapy was included in the structure of the CBT sessions. The CBT helped to replace the patient's misperceptions of her disease and maladaptive behaviour towards pain and anxiety with alternative, realistic ideas about her disease, adaptive behaviour towards pain and anxiety. The interdisciplinary treatment resulted in the conversion from chronic to episodic migraine, regression of LIH, and significant improvement of her emotional state in just 3 months. At the 12-month follow-up the treatment showed a persistent positive effect.