Donald Penzien

Followers

Following

Co-authors

Public Views

Marie-Fleur Albecker

Université d'artois

Patchen Markell

Cornell University

Albert Alejandro Ávila

Pontificia Universidad Javeriana

Manuel Aalbers

KU Leuven

Dr. Balraj Kumar

LOVELY PROFESSIONAL UNIVERSITY

Tulay Kansu

Hacettepe University

Mukesh Yadav

Agra University

Anders Hougaard

University of Copenhagen

Souvik Basu

Heritage Institute Of Technology,Kolkata

Prema Kirubakaran

University of Madras chennai

Interests

Uploads

Papers by Donald Penzien

Development of a computer application for headache diagnosis: The headache diagnostic system

A computer-assisted decision support system for headache classification and diagnosis is presente... more A computer-assisted decision support system for headache classification and diagnosis is presented. The system provides: structured headache data collection, automated data quality control and management, and automated headache classification. The system is based upon headache classification and diagnostic criteria recently developed by the International Headache Society. Development, logical structure and validation of the system are discussed. The system is shown to provide a general improvement in headache classification reliability and has utility for validation and improvement of present headache classification criteria.

Download

Pharmacological versus non-pharmacological prophylaxis of recurrent migraine headache: a meta-analytic review of clinical trials

Pain, 1990

In order to generate information about the relative effectiveness of the most widely used pharmac... more In order to generate information about the relative effectiveness of the most widely used pharmacological and non-pharmacological interventions for the prophylaxis of recurrent migraine (i.e., propranolol HCl and combined relaxation/thermal biofeedback training), meta-analysis was used to integrate results from 25 clinical trials evaluating the effectiveness of propranolol and 35 clinical trials evaluating the effectiveness of relaxation/biofeedback training (2445 patients, collectively). Meta-analysis revealed substantial, but very similar improvements have been obtained with propranolol and with relaxation/biofeedback training. When daily recordings have been used to assess treatment outcome, both propranolol and relaxation/biofeedback have yielded a 43% reduction in migraine headache activity in the average patient. When improvements have been assessed using other outcome measures (e.g., physician/therapist ratings), improvements observed with each treatment have been about 20% greater. In both cases, improvements observed with propranolol and relaxation/biofeedback have been significantly larger than improvement observed with placebo medication (14% reduction) or in untreated patients (no reduction). Meta-analysis thus revealed substantial empirical support for the effectiveness of both propranolol and relaxation/biofeedback training, but revealed no support for the contention that the two treatments differ in effectiveness. These results suggest that greater attention should be paid to determining the relative costs and benefits of widely used pharmacological and non-pharmacological treatments.

Chest pain self-management training for patients with coronary artery disease

Journal of Psychosomatic Research, 1994

This study was designed to evaluate the efficacy of a brief, structured pain management program t... more This study was designed to evaluate the efficacy of a brief, structured pain management program to improve control over chest pain episodes in patients diagnosed with coronary artery disease. Twenty-six male veterans who attended the three-session program were compared with twenty-six matched controls. Results indicated significant short-term reductions in self-report of number of chest pain episodes in treated subjects. Self-report of pretreatment daily physical activity level moderated treatment outcome, as individuals reporting lower levels of physical activity derived greater benefit than their high-activity counterparts. These results suggest the potential utility of incorporating chest pain control strategies into comprehensive cardiac rehabilitation programs.

Client variables and the behavioral treatment of recurrent tension headache: A metaanalytic review

Journal of Behavioral Medicine, 1986

Meta-analysis revealed that in studies evaluating behavioral treatments for tension headaches, th... more Meta-analysis revealed that in studies evaluating behavioral treatments for tension headaches, the treatment outcome has varied with the client samples (e.g., age, gender, referral source) that have been used but not with the treatment procedures (e.g., type of behavioral intervention, length of treatment, whether or not efforts were made to facilitate transfer of training) or the research designs (e.g., internal validity, explicitness of diagnostic criteria) that have been used. Mean client age proved the best predictor of treatment outcome, accounting for 30% of the outcome variance following behavior therapy. Significantly poorer outcomes have also been reported in recent studies than were reported in early studies. These findings suggest that (1) outcomes obtained with behavioral interventions have been less dependent upon the treatment variables that have been the primary focus of research attention than upon characteristics of client samples and (2) behavioral interventions may be less effective in reducing headache activity than has previously been assumed.

Download

The Relationship of Ovarian Steroids, Headache Activity and Menstrual Distress: A Pilot Study With Female Migraineurs

Headache: The Journal of Head and Face Pain, 1992

Fourteen female volunteers who met diagnostic criteria for migraine headache monitored their head... more Fourteen female volunteers who met diagnostic criteria for migraine headache monitored their headache activity and menstrual distress symptoms for one menstrual cycle. Serum estradiol and progesterone levels, and menstrual distress measures were collected at four points of the menstrual cycle: menstrual, ovulatory, luteal and premenstrual. Results indicated that one patient (7.1%) had menstrual migraine, 10 patients (71.4%) had menstrually-related headache and 3 (21.4%) had migraine headache unrelated to their menstrual cycle: subsequent analyses were conducted with the first two groups. Headache activity for the sample was highest during the premenstrual phase. Headache activity during the luteal and premenstrual phases was related to luteal phase progesterone levels. Menstrual distress was highest during the menstrual and premenstrual phases of the cycle, and these symptoms were related to higher estradiol levels, higher estradiol/progesterone ratios, and increased headache activity. These results indicated that for women with menstrual migraine or menstrually-related migraine, luteal progesterone and estradiol and the estradiol/progesterone ratio may be significantly related to menstrual distress during the premenstrual phase of the cycle. The estradiol/progesterone ratio was not more related to headache or menstrual distress than either of these ovarian hormones alone. Suggestions for future research in this area are offered.

Psychosocial Interventions in the Management of Recurrent Headache Disorders 1: Overview and Effectiveness

Behavioral Medicine, 1994

This is the first in a series of three articles addressing nonpharmacologic therapies for managem... more This is the first in a series of three articles addressing nonpharmacologic therapies for management of recurrent migraine and tension-type headache. It provides an overview of the commonly employed nonpharmacologic therapies for recurrent headache, reviews scientific evidence of their efficacy, and identifies the psychosocial interventions that have the greatest potential to enhance the management of recurrent migraine and tension-type headache in primary care settings internationally. In the second article, the authors offer practical guidelines for the administration of recommended nonpharmacologic interventions. The third article explores healthcare policy implications involved in a decision to incorporate psychosocial interventions into primary care practice.

Psychiatric Aspects of Headache

Archives of Neurology, 1994

In the past 35 years, over 300 studies have examined interrelationships between psychological fac... more In the past 35 years, over 300 studies have examined interrelationships between psychological factors and recurrent headache—a testament to the importance of the content area of this book. Directed toward a broad readership (ie, neurologists, family practitioners, internists, and social workers), this volume's 33 brief chapters provide an introduction to a variety of issues pertaining to psychological factors and headache. This edited volume is divided into five sections including conceptualizations of headache, assessment, psychiatric aspects of specific headache syndromes, psychobiology of stress and headache, and treatment. We agree with the editors in their acknowledgment that this work was an ambitious undertaking; despite their valiant effort and partial success, we found the book lacking in several important respects. Perhaps our most critical concern is the tendency for a number of the chapters to unnecessarily characterize the average headache patient in psychopathologic terms. Although the editors preface this volume with a disclaimer

Study design for a randomized clinical trial of cognitive-behavioral therapy for posttraumatic headache

Contemporary Clinical Trials Communications

Posttraumatic headache (PTH) is a common debilitating condition arising from head injury and is h... more Posttraumatic headache (PTH) is a common debilitating condition arising from head injury and is highly prevalent among military service members and veterans with traumatic brain injury (TBI). Diagnosis and treatment for PTH is still evolving, and surprisingly little is known about the putative mechanisms that drive these headaches. This manuscript describes the design of a randomized clinical trial of two nonpharmacological (i.e., behavioral) interventions for posttraumatic headache. Design of this trial required careful consideration of PTH diagnosis and inclusion criteria, which was challenging due to the lack of standard clinical characteristics in

Download

Sleep and Quality of Life in Headache and Migraine

Sleep and Quality of Life in Clinical Medicine, 2008

Headache and sleep disorders are prevalent, comorbid conditions that challenge physical as well a... more Headache and sleep disorders are prevalent, comorbid conditions that challenge physical as well as psychosocial well-being. Headache is the most common pain-related complaint and the seventh leading ailment seen in medical practice, accounting for 18 million physician visits annually in the USA alone (1). Though historically headache often has been trivialized (perhaps because pain is not easily quantified and headache does not generally compromise life expectancy), headache is in a major quality of life (QOL) concern. In fact, migraine headache is among the 20 leading causes of "years lived with disability" according the World Health Report (2). The burden of headache is increasingly appreciated in psychological, family and interpersonal, vocational, and economic realms. Headache, particularly in its more chronic and severe forms, has been linked to sleep disorders. Interestingly, the sleep disorders associated with headache are varied in nature, including obstructive sleep apnea, periodic limb movement disorder, circadian rhythm disorder, insomnia, and hypersomnia. General symptom patterns, particularly morning headache and chronic daily headache, are suggestive of and aid in recognition of a sleep disorder. Management of the sleep disorder may improve or resolve the headache; sleep-disordered breathing is the most empirically supported example of this relationship. Although pure sleep-related headaches, such as hypoxemia-related headache, are less prevalent and more easily recognized, primary headaches as well are often impacted to some degree by sleep. Irrespective of sleep disorders, variation in the sleep/wake schedule is one of the most common acute headache precipitants while sleeping is one of the most common palliative responses to headache. Insomnia is the sleep disorder most often cited by clinical headache populations. Despite an emerging literature supporting the interdependence of sleep and headache, our understanding of the underlying mechanisms remains speculative. Few well-controlled studies are available, and it is difficult to generalize results across sleep and headache literatures due to inconsistencies in diagnostic nosologies, lack of standardized outcome measures, and varied populations. Future research with improved methods is needed to identify mediating factors between sleep and headache. This chapter reviews the co-morbidity of headache and sleep disorders, prevalence, diagnostic considerations, societal and individual burden of headache, clinical implications, and considerations for future directions.

Download

Daily Headache Self-Monitoring Form

Sleep and headache disorders

Sleep and Psychosomatic Medicine, 2007

Direct Costs of Preventive Headache Treatments: Comparison of Behavioral and Pharmacologic Approaches

Headache: The Journal of Head and Face Pain, 2011

This study provides preliminary data and a framework to facilitate cost comparisons for pharmacol... more This study provides preliminary data and a framework to facilitate cost comparisons for pharmacologic vs behavioral approaches to headache prophylactic treatment. There are few empirical demonstrations of cumulative costs for pharmacologic and behavioral headache treatments, and there are no direct comparisons of short- and long-range (5-year) costs for pharmacologic vs behavioral headache treatments. Two separate pilot surveys were distributed to a convenience sample of behavioral specialists and physicians identified from the membership of the American Headache Society. Costs of prototypical regimens for preventive pharmacologic treatment (PPT), clinic-based behavioral treatment (CBBT), minimal contact behavioral treatment (MCBT), and group behavioral treatment were assessed. Each survey addressed total cost accumulated during treatment (ie, intake, professional fees) excluding costs of acute medications. The total costs of preventive headache therapy by type of treatment were then evaluated and compared over time. During the initial months of treatment, PPT with inexpensive mediations (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.75 $/day) represents the least costly regimen and is comparable to MCBT in expense until 6 months. After 6 months, PPT is expected to become more costly, particularly when medication cost exceeds 0.75$ a day. When using an expensive medication (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;3 $/day), preventive drug treatment becomes more expensive than CBBT after the first year. Long-term, and within year 1, MCBT was found to be the least costly approach to migraine prevention. Through year 1 of treatment, inexpensive prophylactic medications (such as generically available beta-blocker or tricyclic antidepressant medications) and behavioral interventions utilizing limited delivery formats (MCBT) are the least costly of the empirically validated interventions. This analysis suggests that, relative to pharmacologic options, limited format behavioral interventions are cost-competitive in the early phases of treatment and become more cost-efficient as the years of treatment accrue.

The Impact of Cigarette Smoking on Headache Activity In Headache Patients

… : The Journal of …, 1991

The present study was designed to explore the relationship between cigarette smoking and headache... more The present study was designed to explore the relationship between cigarette smoking and headache activity in a sample of patients presenting for treatment. Subjects completed various self-report measures and monitored headache activity four times per day over a 4-week period. Analyses revealed that smokers experienced greater weekly peak headache intensity, and reported higher levels of depression and general physical symptoms. Among smokers, nicotine content of the preferred brand was associated with mean headache index and weekly headache-free days, as well as depression and anxiety scores. Daily smoking rate and pack-year history were related to level of general physical symptoms only. Thus, both smoking status and the nicotine content of the preferred cigarette appear to adversely impact headache activity. Further, smokers who are more anxious or depressed may increase their headache activity via their preference for higher nicotine-content cigarettes. These results are discussed in the context of possible mechanisms underlying these effects, and implications for the clinical management of headache suffers who smoke.

Randomized Controlled Trial of Nurse-Delivered Cognitive-Behavioral Therapy Versus Supportive Psychotherapy Telehealth Interventions for Chronic Back Pain

The journal of pain : official journal of the American Pain Society, Jan 16, 2018

This study evaluated a nurse-delivered, telehealth intervention of cognitive-behavioral therapy (... more This study evaluated a nurse-delivered, telehealth intervention of cognitive-behavioral therapy (CBT) versus supportive psychotherapy for chronic back pain. Participants (N = 61) had chronic back pain (pain "daily" ≥6 months at an intensity of ≥4 of 10 scale) and were randomized to an 8-week, 12-session, CBT or to supportive care (SC) matched for frequency, format, and time, with each treatment delivered by a primary care nurse. The primary outcome was the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes included the numeric rating scale (NRS) and the Patient Global Impressions Scale (CGI). CBT participants (n = 30) showed significant improvements on the RMDQ (mean = 11.4 [SD = 5.9] vs 9.4 [SD = 6.1] at baseline and post-treatment, respectively, P < .05; d = .33), NRS (mean = 4.9 [SD = 2.1] vs 4.0 [SD = 1.9], respectively, P < .05; d = .45), and on the CGI (39.1% reporting "much improved" or "very much improved"). SC participants ...

Pain worsening with physical activity during migraine attacks in women with overweight/obesity: A prospective evaluation of frequency, consistency, and correlates

Cephalalgia : an international journal of headache, 2017

Background Migraine is a neurological disease involving recurrent attacks of moderate-to-severe a... more Background Migraine is a neurological disease involving recurrent attacks of moderate-to-severe and disabling head pain. Worsening of pain with routine physical activity during attacks is a principal migraine symptom; however, the frequency, individual consistency, and correlates of this symptom are unknown. Given the potential of this symptom to undermine participation in daily physical activity, an effective migraine prevention strategy, further research is warranted. This study is the first to prospectively evaluate (a) frequency and individual consistency of physical activity-related pain worsening during migraine attacks, and (b) potential correlates, including other migraine symptoms, anthropometric characteristics, psychological symptoms, and daily physical activity. Methods Participants were women (n = 132) aged 18-50 years with neurologist-confirmed migraine and overweight/obesity seeking weight loss treatment in the Women's Health and Migraine trial. At baseline, parti...

Randomized Controlled Trial of Telephone-Delivered Cognitive Behavioral Therapy versus Supportive Care for Chronic Back Pain

The Clinical Journal of Pain

To evaluate the efficacy of a telephone-delivered, home-based cognitive behavioral intervention f... more To evaluate the efficacy of a telephone-delivered, home-based cognitive behavioral intervention for chronic low back pain in comparison to a matched supportive care treatment. Participants (N=66) were patients with chronic back pain that were randomized to either an 8-week Cognitive-Behavioral Therapy (CBT) or a Supportive Care condition (SC) matched for contact frequency, format, and time. Participants completed validated measures of improvement in back pain disability, pain severity, and overall improvement. Intent-to-treat analyses at post-treatment showed that the treatment groups showed non-significantly different improvements in back pain disability (mean changes=-2.4 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; -2.6 for CBT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; SC, respectively; Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s d&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s=0.49 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; 0.55, respectively) and reductions in pain severity (mean changes=-0.9 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; -1.4 for CBT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; SC respectively; Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s d&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s=0.50, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; 0.90, respectively). Participants rated their overall improvement levels at 31% (CBT) versus 18.5% (SC). Results from this clinical trial suggest that home-based, telephone-delivered CBT and SC treatments did not significantly differ in their benefits for back pain severity and disability, and may warrant further research for applications to hospital settings. Major limitations included recruitment difficulties that underpowered primary analyses, the lack of objectives improvement measures, and the absence of a usual care/untreated control group for comparisons.

Reduction in Pain Medication Prescriptions and Self-Reported Outcomes Associated with Acupuncture in a Military Patient Population

Medical Acupuncture

Background: Acupuncture is being offered to patients as part of routine medical care in selected ... more Background: Acupuncture is being offered to patients as part of routine medical care in selected military bases in the United States. There is little published information about the clinical outcomes associated with acupuncture in these clinical settings. Objective: The goal of this research was to assess clinical outcomes observed among adult patients who received acupuncture treatments at a United States Air Force medical center. Materials and Methods: This retrospective chart review was performed at the Nellis Family Medicine Residency in the Mike O&#39;Callaghan Military Medical Center at Nellis Air Force Base in Las Vegas, NV. The charts were from 172 consecutive patients who had at least 4 acupuncture treatments within 1 year. The main outcome measures were prescriptions for opioid medications, muscle relaxants, benzodiazepines, and nonsteroidal anti-inflammatory drugs (NSAIDS) in the 60 days prior to the first acupuncture session and in the corresponding 60 days 1 year later; and Measure Yourself Medical Outcome Profile (MYMOP2) values for symptoms, ability to perform activities, and quality of life. Results: Opioid prescriptions decreased by 45%, muscle relaxants by 34%, NSAIDs by 42%, and benzodiazepines by 14%. MYMOP2 values decreased 3.50-3.11 (P &lt; 0.002) for question 1, 4.18-3.46 (P &lt; 0.00001) for question 3, and 2.73-2.43 (P &lt; 0.006) for question 4. Conclusions: In this military patient population, the number of opioid prescriptions decreased and patients reported improved symptom control, ability to function, and sense of well-being after receiving courses of acupuncture by their primary care physicians.

Time-Series Analysis of Stress and Headache

Cephalalgia

Forecasting Individual Headache Attacks Using Perceived Stress: Development of a Multivariable Prediction Model for Persons With Episodic Migraine

Headache, 2017

To develop and validate a prediction model that forecasts future migraine attacks for an individu... more To develop and validate a prediction model that forecasts future migraine attacks for an individual headache sufferer. Many headache patients and physicians believe that precipitants of headache can be identified and avoided or managed to reduce the frequency of headache attacks. Of the numerous candidate triggers, perceived stress has received considerable attention for its association with the onset of headache in episodic and chronic headache sufferers. However, no evidence is available to support forecasting headache attacks within individuals using any of the candidate headache triggers. This longitudinal cohort with forecasting model development study enrolled 100 participants with episodic migraine with or without aura, and N = 95 contributed 4626 days of electronic diary data and were included in the analysis. Individual headache forecasts were derived from current headache state and current levels of stress using several aspects of the Daily Stress Inventory, a measure of d...