Pacing as a treatment modality in migraine and tension-type headache

Abstract

Purpose: To review the pacing literature; describe the use of pacing in a specialty headache clinic; and provide client feedback regarding the effectiveness of pacing in headache self-management. Method: The evidence for this report was derived from a structured literature review, an established pacing intervention program for patients with headache, and patient self-report questionnaire. Results: There are frequent references to pacing in the chronic pain and rheumatic disease literature, but no universal definition and, until recently, few outcome studies. References to pacing in the headache literature are limited. For a small sub-group of clients at a specialty headache clinic (n = 20), pacing principles taught by occupational therapists were reported to prevent increases in headache intensity (70%); decrease headache intensity (65%), and shorten the duration of a headache (40%). Additionally, 70% of respondents used pacing to prevent headache onset. Pacing was seen to contribute to increased quality of life, headache self-efficacy, function, and independence. There were a variety of opinions regarding the most helpful pacing components. The most frequently endorsed were identify and prioritize responsibilities; balance activity and rest; schedule regular rest breaks; and delegate or eliminate tasks. Conclusions: Pacing appears to play an important role in headache self-management. More pacing research is required in both headache and chronic pain populations.

Implications for Rehabilitation

• Migraine and tension-type headaches are associated with significant pain and disability.

• Overexertion and stress are commonly reported headache triggers.

• Activity pacing allows individuals with migraine and tension-type headache to self-regulate tasks and activities so they may manage physical exertion and mental stress levels.

• Pacing may help decrease headache intensity and duration, as well as increase quality of life, function, and self-efficacy.

Keywords::

• Migraine
• headache
• pacing
• occupational therapy

Acknowledgements

The authors wish to thank Dr. Cary Brown for her assistance and support.

Declaration of interest: The authors report no conflict of interest.