Lifestyle Counseling from Nurses May Improve Patient Outcomes
by Deena Kuruvilla, MD
In this month’s edition of Headache, researchers showed that nurse counseling on lifestyle changes along with treatment by a physician improves the functioning and quality of life of migraine patients. Leroux et. al. followed patients over 1 year. 200 patients were randomized for visits with a physician or visits with a physician and a nurse. During their encounter with nursing, the patients were “motivated” to make lifestyle modifications in the following areas such as tobacco use, caffeine use, stress management, weight management, medication overuse, nutrition, exercise, sleep and acute medication management. This study showed that with nursing intervention, headache impact test (HIT-6) scores improved. HIT-6 is a questionnaire used to measure the effect headaches have on your ability to function at work, school, home or in social situations. The goal with this questionnaire is to help migraine patients communicate how they feel and how restricted they are in participating in everyday activities. If the patient has scored a 50 points or higher, they have significant disability from migraine. While the HIT-6 improved in patients in the group with exposure to nursing, the patient’s headache frequency, severity and abortive headache medication use did not change.
This study adds to existing studies which show the benefits of a multi-disciplinary approach to headache management. Some Headache practices have physicians, nurses, clinical psychologists, social workers, physical therapists, dieticians and complementary and integrative medicine providers in order to offer patients a well-rounded experience under one roof. Studies have shown that patients have a better outcome with this approach. In fact, Headache published an article July 2017 which reviewed some of the data and benefits of having multidisciplinary teams in headache practice. Sahai- Srivastava et. al. state “there is more of a consensus on the specifics of multi-disciplinary teams in Europe than in the United States. In a meeting of the European Headache Federation and Migraine Trust, there was agreement regarding the utility of multi-disciplinary teams for primary headaches. The components of multi-disciplinary teams introduced included a “Headache School” aimed at patient education, empowerment, and peer support, and a “Headache nurse” who would participate in direct care and case planning.” This particular paper advises headache practitioners to incorporate physical therapy, occupational therapy and psychology in their teams.
While Headache providers differ in opinion on which teams to incorporate in their headache practices, the general consensus is that multi-disciplinary teams improve the patient’s overall well-being.