So this would be a typical example of a complex patient that we address, and we, and I'll show you how that goes from simple to complex. So here's just a list of contributing factors that are important for headache. Many of these I've already talked to you about. Caffeine use, muscular factors, hormonal issues. Psycho-socio factors, medication overuse, sleep, and then managing the triggers. I haven't mentioned much about social factors, but occasionally we, we see people that are been involved in car accidents and litigation and workers comp. Those are all social factors that contribute to stress and you can talk to anybody that's involved in any kind of insurance issues, in those settings, it's a very stressful time and part of managing your headaches and managing chronic pain in those situations. Is your, your plan has to include a way to get out of that whole situation? You need to bring your litigation to closure. You need to get out of it. And you need to, maximize your recovery and move on. But you need be, have, that has to be part of your plan. You can't wait to get better first. And then get outta the workers comp, or then get out of the person injury. Because it doesn't happen that way, they gotta be managed simultaneously, at the same time. And with the, your exit strategy is part of your recovery and healing process. This is a slide from Doctor Frikten. That shows how often things progress when you're going from acute to a chronic to intractable conditions and you can see that initially there's just mainly behavioral factors at the start and there's acute pain, but over time as things become chronic, other factors become more salient. Reactive to the, to the situation related to sleep disturbance and activity. And eventually you get to the point where there's now these social factors that become dominant and need to be addressed. When we do this, you have to start here and work your way back, but you have to address. All areas at the same time. You can't skip any areas. [BLANK_AUDIO] So looking at the, the layers of the onion, these are the most simple cases. Least severe, good physical, psychological functioning. Limited pain problems. We're talking about a, a very local pain problem. Such as headache. We're not talking about headache, jaw pain, neck pain, and back pain. We often give people a timer or we often use post it notes. Tend to put five post it notes around their house and every time they see a post it note they do a little mini break. Loosen up their necks, stretch out their jaw. I use a lot of hypnosis for the management of pain and headache. Simple hypnosis for relaxation and pain reduction is very effective in these simple cases. Easy to learn and very helpful. Talk about getting regular exercise. Appropriate diet, not skipping meals. And using meals as a kind of a routine to take little mini breaks. Every time you take a break for din, lunch, you do a little mini break. Every time you take a break for dinner you do a little mini break. And then we have course to some medications and physical therapy. As things progress we talk about level two interventions now we're really diving into addressing more contributing factors. There might be a specific stressor at work or stress management skills in general. They might be issues relating to reactive or situational depression or anxiety. Sometimes we have to what we call proproceptive awareness training where we actually teach people to learn to recognize muscle tension. Teach people to recognize their posture. Recognize that they're clinching their teeth. And then we do a lot of monitoring at this point to kind of put the, it all together, and how it fits into their life. This doesn't work, then we do level three interventions and here we get down to really deep, deep issues regarding pain and headaches. We really have to address medication overuse at this time. We have to address any social factors that might be contributing. Sometimes we have to address mo-, motivation for self-care. Are you willing to put the time and effort in to rehabilitate, to gradually, incrementally make the changes. That improve. It's important for me to mention although I'm not going to go into great detail, we talk about state dependent aspects of pain. And what do I mean by that? And, if I could just use myself as an example, you can see I have the creases right here across my forehead. So when I'm deep in thought. I'm a squinter. That's a state-dependent pattern and helping people learn to recognize the difference states they live in and the physiology that goes with those state, those different patterns is really helpful in addressing the more complex cases. Always when we're dealing with complex cases at this level, there's also an incremental change, gradual change, because we're addressing so many factors. Now when we looked at this many years ago, it was an average of about 11 factors on these complex cases that needed to be addressed to lead to improvement and healing what they're chronic pain problems. To summarize and in conclusion, when we're looking at management of headaches,. There's multiple factors that contribute to the onset progression of headaches that need to be addressed. Need to be addressed in the prevention of chronic headaches. There are, when we look in the area of migraine. We are talking about these pain systems become hyper excitable. We're talking about the impact of stress and trauma on the body. What happens with medication overuse. Some of the mind-body cycles I've talked to you about and are transmitters. There's obviously a genetic predisposition for migraine. And last I don't want people to forget about the muscle factors. Both in terms of clenching, squinting and turtling. And how we address those in a comprehensive manner to for improvement. This will end my presentation today. I thank you all for taking the course. And I, I hope you find some of this information. exciting, informative and useful. Thank you again. [BLANK_AUDIO]
