(Q2A). There is some evidence of modest benefit from treatment groups led by trained nonprofessionals.[32, 33] The shortage of behavioral headache treatment providers within medical settings has likely contributed to the underuse of evidence-based behavioral interventions, and training a larger number of behavioral providers remains a significant need. The physiological or psychological mechanisms that underlie the effects

of evidence-based behavioral and mind/body practices are not fully understood (Q3). Many are multi-component interventions, and thus more than one mechanism may be responsible for therapeutic effects; possible selleck chemical synergistic effects

among treatment components might explain particularly long-lasting effects. Better understanding of the mechanisms of action of these interventions would allow refinement and targeting of treatments to improve clinical benefits, increase patient/provider interest and adherence, and enhance scientific credibility among those who view their benefits as resulting primarily from nonspecific processes.[34] For example, it would be helpful to understand how these interventions affect headache threshold(s) (Q3A) in order to target interventions and understand mechanisms of action. Specifically, such techniques may increase the distance between an individual’s headache baseline and 17-AAG in vitro headache threshold by (A) lowering the individual’s baseline level of brain excitability; (B) raising an individual’s headache threshold, or; (C) both ( Figure). The extensive research on evidence-based behavioral interventions and growing research on mind/body practices indicates that these treatments are generally acceptable, safe, and without

significant side effects.2,7,8,11-13,35 However, anecdotal reports of musculoskeletal injuries with certain types of yoga practices exist in the media,[36] and rare case reports of meditation-induced psychosis Selleck BIBF-1120 have been reported,[37] although recent studies have demonstrated the benefit of mindfulness-based interventions even in adults with psychosis.38-40 Better reporting and understanding of the potential harms, patient acceptability, and adverse events associated with these practices are additional research priorities and will facilitate comparisons of these treatments with conventional medication treatments (Q4). Another priority is the development, testing, publication, and dissemination of standardized intervention protocols that are feasible for use in clinical practice (Q5).[41] Treatment manuals are not routinely published, presenting a barrier for widespread dissemination.