CAM You can Use: Preventing Headaches. Kathi J Kemper, MD, MPH General Pediatrics, Integrative Medicine 2 nd Opinion Clinic (Monday mornings) email@example.com 716-9640. Disclaimer.
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Kathi J Kemper, MD, MPH
General Pediatrics, Integrative Medicine
2nd Opinion Clinic (Monday mornings)
By the end of this session, participants will be able to
Rossi et al. Headache 46:622-631, 2006
* CAM – Complementary or Alternative Medicine, somewhat outdated and useless term
- Lack of sleep
- Missing meals
!!KEEP A HEADACHE DIARY!!
Mansfield L et al.. Ann Allergy, 2004
Schoenen. Neurology, 1998; Sandor. Headache, 2000; Magis. Headache, 2007
Schoenen J et al. Effectiveness of high-dose riboflavin in migraine prophylaxis: a randomized controlled trial. Neurology 50(2): 466-70; 1998.
Thys-Jacobs. J Am Coll Nutr, 2000
Mauskop. Headache, 2002; Pfaffenrath. Cephalgia, 1996
Mazzotta. Cephalgia, 1999; Wang, Headache, 2003
Peikert. Cephalgia, 1996; Facchinetti F, Headache, 1991
* OPTIONAL SLIDE – for participant reference
Mauskop A. Alternative therapies in headache – Is there a role? Medical Clinics of North America 85(4): 1077-84; 2001.
Mann, Doug et al. “Migraine and Tension-Type Headache.” Integrative Medicine. Ed. David Rackel MD. Philadelphia: Sanders, 2006 143-156.
Omega-3 Fatty Acids
Linoleic Acid (18:2n-6)
a-Linolenic Acid (18:3n-3)
(GLA)γ -Linolenic Acid (18:3n-6)
Stearidonic Acid (18:4n-3)
(DHGLA) Dihomo-γ-Linolenic Acid (20:3n-6)
Eicosatetraenoic Acid (20:4n-3)
(AA)Arachidonic Acid (20:4n-6)
(EPA) Eicosapentaenoic Acid (20:5n-3)
(DHA) Docosahexaenoic Acid (22:6n-3)
Harel. J Adolesc Health, 2002
Pradalier. Cephalgia, 2001
Puel. Br J Nutr, 2004
Rozen and Silberstein, Cephalalgia 22: 137-141, 2002
Rozen. Headache, 2006
Vogler. CNS Drugs, 2006
Rozen, Neurology, 2003
Pringsheim. Headache, 2002
Miano. Neurol Sci, 2008 – PEDIATRIC STUDY
High Arousal/High Energy
Low Arousal/Low Energy
Institute of HeartMath
Use of electronic equipment to measure and feed back information about physiologic functions—which are then modulated in desirable direction
Goal-balancing ANS (& CNS) activity
“video-games for your body” kid-friendly
2007 meta-analysis showed > 50 controlled trials of BF for HA; EFFECTIVE!
Strong treatment effect that persists for over 12 months after training
Allen Pediatr Ann, 2004
Kaushik R. Complement Ther Health Med, 2005
Trautman. Cephalgia, 2006
Nestoriuc. Pain, 2007
Blanchard E et al.. J Consult Clin Psychol; 1990.
Home or Office Use
Heart Rate Variability
Theory-the more relaxed, the lower sympathetic nervous system activity, the more peripheral blood flow, hands and feet warm up
Dermatherm Bands Sharn, Incorporated www.sharn.com
Digital Temp Portable Units
2.5 seconds of heart beat data
Hypnosis: An altered state of awareness usually but not always involving relaxation during which the participant can give himself/herself suggestions for desired changes to which he/she is more likely to respond that in their usual state of awareness.
Guided Imagery: A technique that involves using the imagination and mental images to promote relaxation, changes in attitude or behavior, and encourages physical healing. AKA- visualization.
To teach self hypnosis for a specific purpose (such as reduction of pain or elimination of a habit) involves helping young children focus on their natural thinking styles.
Kids move in and out of altered states and imaginary activities all the time. Think IMAGINARY PLAY!
The child is in control.
We serve as the teacher or coach.
Offer choices and options.
The child can use this skill when he or she chooses.
Ask that parents not remind the child to practice self hypnosis; it’s up to the child/adolescent
Olness. Pediatrics. 1987
Hammond: Int J Clin Exp Hypn. 2007
Patient is under control of the hypnotherapist
Patient is unaware of surroundings and/or activities around him/her
Patients defenses are impaired (there is improved access to subconscious material)
Symptoms are masked
Patient can be forced to do things they would not normally do
Ignoring underlying disorder
Used for fun or entertainment
The problem is more effectively treated with another modality
Patient is psychotic, acutely depressed
Patient (child) does not want to engage in hypnosis (but parent wants them to)
Zsombok. Headache, 2003
Juhasz. Headache, 2007
Lawler SP. Ann Behav Med, 2006
Pieovesan. Arq Neuropsiquiatr, 2007
Tuchin. Australas Chiropr Osteopathy, 1997
Parker. Aust NZ J Med, 1978
Hoyt. J Am Osteopath Assoc, 1979
Fernandez-de-las-Penas. J Orthop Sports Phys Ther, 2006
Bronfort. J Manipulative Phys Ther, 2001
Coeytaux R. Headache, 2005
Gottschling. Pain, 2008 – PEDIATRIC STUDY LASER ACUP.
Witt. Cephalgia, 2008 – COST EFFECTIVENESS
Morrisey, H et al. Headache 43, 221-228, 2003
Vincent C. A controlled trial of the treatment of migraine by acupuncture. Clinical Journal of Pain. 5(4): 305-12; 1989.
Melchart et al. Cephalalgia, 1999
Manias.The Clinical Journal of Pain, 2000
And Therapeutic Touch
Keller E. Nurs Res, 1986
Murphy J et al.. Lancet 1988.
Ernst E et al.. Public Health Nutrition .2000.
Acupressure / acupuncture
www.heartmath.com(products and training)
Be the Boss of Your Body” Series
“Ways to Wellness” Videos
Music and Recorded Relaxation Exercises
Home Computer Biofeedback Fun
Society For Developmental and Behavioral Pediatrics Annual Pediatric Hypnosis Training
American Society for Clinical Hypnosis
Society for Clinical and Experimental Hypnosis
International Society for Hypnosis
Academy for Guided Imagery
Culbert & Olness, ed: Integrative Pediatrics
In press, March 2009 (Oxford University Press)
Loo: Integrative Medicine for Children (2008)
Rosen & Riley, ed: Complementary and Alternative Medicine, Pediatric Clinics of North America (December 2007)
Schwartz & Andrasik: Biofeedback: A Practitioners Guide
Shannon: Handbook of Complementary and Alternative Therapies in Mental Health
Schnaubelt: Medical Aromatherapy
Reed Gach: Acupressure Potent Points
Arcury (Family Med)
Avis (Public Health)
Atkinson (Business Dev.)
Parker (Home & Community)
Yates (Pastoral Care)
Bailey: Ambience Sound/Music
Black: ActionHealth/ Farmer’s Market
Feldman: Guided imagery
Kilbourne: Green Initiative
LaRose: HM – Hospital
Larrimore – Healing Touch/HeartMath
McClenny – Arts
Melcher – Massage
NW Area Health Education Center
Sackett – RN Research
Wilson – Recreation/Aqua
Woodard - Nutrition
Zachary – Healthy Living
Julie Milunic: Advisory Board
Library Staff: resources
Mark Wright: PR and Marketing
Better focus or concentration
Greater calm More resilience
More cheerfulness Greater adaptability
More confidence More creative
More harmonious relationships
Higher self esteem
More consistent with personal values
0 1 2 3 4 5 6 7 8 9 10
Why did you pick that number and not a lower number? (e.g. a 7 instead of a 5)
Asking this question helps the patient/family provide their own rationale for why this is important. They talk themselves into it!
0 1 2 3 4 5 6 7 8 9 10
If they pick an 8 or higher (pretty confident), proceed with next step of making a chart and planning rewards and follow-up.
If they pick a number less than 8,
“What would it take for you to go from the number you picked to a higher number?” Begin to explore their ambivalence…. It’s OK to be ambivalent about change!
What resources do you have/need to help you make this change? Will Mom commit to getting new shoes, leash, etc. ? Will the child want/need a reminder? Is it helpful for Dad to do that? Do they need a chore chart? A calendar?Identify Barriers and Resources