The Journal of the Arkansas Medical Society Med Journal Aug 2019 Final 2 | Page 11

Body Mass Index (BMI) between 85 th and 95 th
percentile is overweight and above the 95 th percen-
tile is obesity for children and teens of the same
age and sex, per Centers for Disease Control. Obe-
sity is felt to increase the risk of migraine by 40-
80%, with the higher risk for the more obese pa-
tients, especially in those of reproductive age. Dr. B.
L. Peterlin, director of headache research at Johns
Hopkins University School of Medicine in Baltimore,
feels that care providers should promote healthy
lifestyles and exercise for patients with migraine.
Obesity is associated with increased headache fre-
quency and disability regardless of headache type.
Conservative therapies for migraine seem to be
more effective in children younger than six years
than in older children.
Complete resolution of headache is a bonus.
Help patients manage their symptoms without too
much dependence on medication. If the headache
remains the same with decreased use of medi-
cine, that is an improvement. Some patients may
not consider the long-term effects and opt for the
much simpler, quick relief of medication. While oth-
ers may not respond well or have comorbidities
that preclude the use of medications. More than 12
million Americans visit their doctor complaining of
headaches yearly. The cost to society is greater than
$31 billion dollars. A Beth Israel Deaconess Medi-
cal Center study suggests some of that cost could
be offset by physicians ordering fewer tests and
an increased focus on counseling about lifestyle
changes. Long term, and within year one, Minimal
Contact Behavioral Treatment was found to be the
least costly approach to migraine prevention. In the
CHAMP Study, there were no significant differences
in reduction of headache frequency or headache-
related disability in childhood and adolescent mi-
graine with Amitriptyline, Topiramate, or placebo
over a period of 24 weeks. The active drugs were
associated with higher rates of adverse events.
Medication Overuse Headache (MOH) may de-
crease quality of life, cause daily and incapacitating
headaches, insomnia, and non-restorative sleep,
as well as psychological distress and reduced func-
tioning. MOH is associated with biochemical, struc-
tural, and functional brain changes.
References
1. Penzien DB, Rains JC, Lipchik GL, Creer TL.
Behavioral interventions for tension-type head-
ache: overview of current therapies and recom-
mendation for a self-management model for
chronic headache. Curr Pain Headache Rep.
2004; 8(6):489-499.
diagnosis, and management. The Lancet Neu-
rology. 2016; 15(11): 1170-1181.
6. Blau JN, Kell CA, Sperling JM. Water-deprivation
headache: A new headache with two variants.
Headache: The Journal of Head and Face Pain.
2004; 44(1):79-83.
2. FDA. Notice to Industry: Final Guidance for
Over-the-Counter Products that Contain Acet-
aminophen. www.fda.gov/Drugs/DrugSafety/
ucm310469.htm. Accessed September 16,
2016. 7. National Headache Foundation. Headache
Sufferers’
Diet.
http://www.headaches.
org/2012/01/13/headache-sufferers-diet/. Pub-
lished January 13, 2012. Accessed September
8, 2016.
3. FDA. FDA Drug Safety Communication: FDA
strengthens warning that non-aspirin nonste-
roidal anti-inflammatory drugs (NSAIDs) can
cause heart attacks or strokes. https://www.
fda.gov/Drugs/DrugSafety/ucm451800.htm.
Published July 9, 2015. Accessed November
21, 2017. 8. Bic Z, Blix GG, Hopp HP, Leslie FM, Schell MJ.
The influence of a low-fat diet on incidence
and severity of migraine headaches. J Womens
Health Gend Based. 1999; 8(5):623-630
4. Penzien DB, Wall EM. Evidenced-Based Guide-
lines For Migraine Headache: Behavioral and
Physical Treatments. http://tools.aan.com/pro-
fessionals/practice/pdfs/gl0089.pdf. Accessed
September 8, 2016.
5. Maski K, Owens JA. Insomnia, parasomnias,
and narcolepsy in children: clinical features,
9. AAP. Energy In Energy Out: Finding the Right Bal-
ance for Your Children. https://docs.google.com/
file/d/0B-H10w3hWogiWnIwbWlKU2Q0UFk/
edit?pli=1. Accessed November 22, 2017.
10. U.S. Department of Health and Human Ser-
vices (HHS). Physical Activity Guidelines for
Americans.
https://health.gov/paguidelines/
guidelines/. Published September 22, 2008. Ac-
cessed April 18, 2017.
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Behavioral Modification may help with mainte-
nance of good health, wellbeing, and management
of life’s stresses including headaches.
Long term goals of BM include reduction of
frequency and severity of headaches, headache-
related disability, reliance on poorly tolerated or
unwanted medications, headache-related distress
and psychological symptoms, and the feeling of not
being in control of their treatment. 4
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