Skip to main content

Advertisement

SpringerLink
Log in

Chronic Headache: The Role of the Psychologist

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

The role of the psychologist in chronic headache needs to be tailored to the patient’s presentation. For some patients, psychological issues need to be directly addressed (eg, psychiatric comorbidity, difficulties coping with headache, significant problems with sleep and/or stress, medication overuse, and history of abuse). Other situations (eg, patients’ beliefs about their readiness to change ability to actively manage headaches, medication adherence, and managing triggers) involve behavioral/psychological principles even when there is no direct contact with a psychologist. This article reviews the literature on the importance of psychological issues in headache management and provides suggestions for how to address behavioral and cognitive factors and their potential for improved headache care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Headache Classification Subcommittee of the International Headache Society: The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004, 24(Suppl 1):9–160.

    Google Scholar 

  2. IASP Task Force on Taxonomy: Part III: pain terms, a current list with definitions and notes on usage. In Classification of Chronic Pain, edn 2. Edited by Merskey H, Bogduk N. Seattle: IASP Press; 1994:209–214.

  3. Lipton RB, Hahn SR, Cady RK, et al.: In-office discussions of migraine: results from the American Migraine Communication Study. J Gen Intern Med 2008, 23:1145–1151.

    Article  PubMed  Google Scholar 

  4. Nicholson RA, Rooney M, O’Laughlin E, et al.: Migraine care among different ethnicities: do disparities exist? Headache 2006, 46:754–765.

    Article  PubMed  Google Scholar 

  5. Hahn SR, Lipton RB, Sheftell FD, et al.: Healthcare provider-patient communication and migraine assessment: results of the American Migraine Communication Study (AMCS) Phase II. Curr Med Res Opin 2008, 24:1711–1718.

    Article  PubMed  Google Scholar 

  6. Maizels M: Why should physicians care about behavioral research? Headache 2005, 45:411–413.

    Article  PubMed  Google Scholar 

  7. Campbell JK, Penzien DB, Wall EM: Evidence-based guidelines for migraine headache: behavioral and physical treatments. US Headache Consortium 2000. Available at http://www.aan.com/professionals/practice/pdfs/gl0089.pdf.

  8. Andrasik F: Behavioral treatment of migraine: current status and future directions. Expert Rev Neurother 2004, 4:403–413.

    Article  PubMed  Google Scholar 

  9. Bigal ME, Lipton RB: Modifiable risk factors for migraine progression (or for chronic daily headaches): clinical lessons. Headache 2006, 46(Suppl 3):S144–S146.

    Article  PubMed  Google Scholar 

  10. Buse DC, Andrasik F: Behavioral medicine for migraine. Neurol Clin 2009, 27:445–465.

    Article  PubMed  Google Scholar 

  11. Penzien DB, Rains JC, Lipton RB: Introduction to the special series on the chronification of headache: mechanisms, risk factors, and behavioral strategies aimed at primary and secondary prevention of chronic headache. Headache 2008, 48:5–6.

    Article  Google Scholar 

  12. Radat F, Lantéri-Minet M, Nachit-Ouinekh F, et al.: The GRIM2005 study of migraine consultation in France. III: Psychological features of subjects with migraine. Cephalalgia 2009, 29:338–350.

    Article  CAS  PubMed  Google Scholar 

  13. The Robert Wood Johnson Foundation: Chronic Care in America: A 21st Century Challenge. San Francisco: The Institute for Health and Aging, University of California; 1996.

  14. Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness. JAMA 2002, 288:1775–1779.

    Article  PubMed  Google Scholar 

  15. Houle TH, Nicholson RA, Smitherman TA, et al.: Psychological factors in primary headache. In Assessment and Management of Headache: The Psychobiological Perspective. Edited by DB Penzien, JC Rains, RB Lipton. Washington, DC: American Psychological Association; 2009 (in press).

  16. Prochaska JO, Redding A, Evers KE: The transtheoretical model and stages of change. In Health Behavior and Health Education. Edited by Glanz K, Lewis FM, Rimer BK. San Francisco: Jossey-Bass; 1997:60–84

    Google Scholar 

  17. •• Nicholson RA, Houle TT, Rhudy JL, Norton PJ: Psychological risk factors in headache. Headache 2007, 47:413–426. This article covers a number of factors that are relevant for all headache sufferers. The authors also, when possible, describe what brain structures are triggered by psychological factors in order to show how psychological factors influence pain.

  18. Bandura A, O’Leary A, Taylor C, et al.: Perceived self-efficacy and pain control: opioid and nonopioid mechanisms. J Personal Social Psychol 1987, 53:563–557.

    Article  CAS  Google Scholar 

  19. Bandura A: Self-Efficacy: The Exercise of Control. New York: W.H. Freeman and Company; 1997.

    Google Scholar 

  20. Martin NJ, Holroyd KA, Penzien DB: The headache-specific locus of control scale: adaptation to recurrent headaches. Headache 1990, 30:729–734.

    Article  CAS  PubMed  Google Scholar 

  21. Rains JC, Lipchik GL, Penzien DB: Behavioral facilitation of medical treatment for headache–part I: review of headache treatment compliance. Headache 2006, 46:1387–1394.

    PubMed  Google Scholar 

  22. •• Rains JC, Penzien DB, Lipchik GL: Behavioral facilitation of medical treatment for headache–part II: theoretical models and behavioral strategies for improving adherence. Headache 2006, 46:1395–1403. This article provides useful “how-to’s” for increasing medication adherence.

  23. Kelman L: The triggers or precipitants of the acute migraine attack. Cephalalgia 2007, 27:394–402.

    Article  CAS  PubMed  Google Scholar 

  24. Martin VT, Behbehani MM: Toward a rational understanding of migraine trigger factors. Med Clin North Am 2001, 85:911–941.

    Article  CAS  PubMed  Google Scholar 

  25. Hamelsky SW, Lipton RB: Psychiatric comorbidity in migraine. Headache 2006, 46:1327–1333.

    Article  PubMed  Google Scholar 

  26. Radat F, Swendsen J: Psychiatric comorbidity in migraine: a review. Cephalalgia 2005, 25:165–178.

    Article  CAS  PubMed  Google Scholar 

  27. •• Lipchik GL, Smitherman TA, Penzien DB, Holroyd KA: Basic principles and techniques of cognitive-behavioral therapies for comorbid psychiatric symptoms among headache patients. Headache 2006, 46(Suppl 3):S119–S132. This article is one of the best for helping explain what is involved in CBT for headache and associated comorbidities.

  28. Smitherman TA, Maizels M, Penzien DB: Headache chronification: screening and behavioral management of comorbid depressive and anxiety disorders. Headache 2008, 48:45–50.

    PubMed  Google Scholar 

  29. • Lake AE III: Headache as a stressor: dysfunctional versus adaptive coping styles. Headache 2009, 49:1369–1377. Prior to this article, there had been no solid article looking at how coping with headache can influence headache management.

  30. Boardman HF, Thomas E, Millson DS, Croft PR: Psychological, sleep, lifestyle, and comorbid associations with headache. Headache 2005, 45:657–669.

    Article  PubMed  Google Scholar 

  31. Ohayon MM: Prevalence and risk factors of morning headaches in the general population. Arch Intern Med 2004, 164:97–102.

    Article  PubMed  Google Scholar 

  32. Scher AI, Lipton RB, Stewart WF: Habitual snoring as a risk factor for chronic daily headache. Neurology 2003, 60:1366–1368.

    CAS  PubMed  Google Scholar 

  33. • Rains JC: Chronic headache and potentially modifiable risk factors: screening and behavioral management of sleep disorders. Headache 2008, 48:32–39. This article provides useful information about how to assess sleep problems and methods to improve sleep hygiene.

  34. • Rains JC, Poceta JS: Sleep and headache disorders: clinical recommendations for headache management. Headache 2006, 46:1344–1363. This provides more methods to improve sleep hygiene.

  35. Calhoun AH, Ford S: Behavioral sleep modification may revert transformed migraine to episodic migraine. Headache 2007, 47:1178–1183.

    Article  PubMed  Google Scholar 

  36. Andrasik F: What does the evidence show? Efficacy of behavioural treatments for recurrent headaches in adults. Neurol Sci 2007, 28:S70–S77.

    Article  PubMed  Google Scholar 

  37. Nestoriuc Y, Martin A: Efficacy of biofeedback for migraine: a meta-analysis. Pain 2007, 128:111–127.

    Article  PubMed  Google Scholar 

  38. Nestoriuc Y, Martin A, Rief W, Andrasik F: Biofeedback treatment for headache disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback 2008, 33:125–140.

    Article  PubMed  Google Scholar 

  39. Rains JC, Penzien DB: Behavioral treatment strategies for migraine and tension-type headache: a review of the evidence and future directions. Expert Rev Neurother 2002, 2:749–760.

    Article  PubMed  Google Scholar 

  40. Holroyd KA, France JL, Cordingley GE, et al.: Enhancing the effectiveness of relaxation-thermal biofeedback training with propranolol hydrochloride. J Consult Clin Psychol 1995, 63:327–330.

    Article  CAS  PubMed  Google Scholar 

  41. Holroyd KA, O’Donnell FJ, Stensland M, et al.: Management of chronic tension-type headache with tri-cyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA 2001, 285:2208–2215.

    Article  CAS  PubMed  Google Scholar 

  42. Nicholson RA, Nash JM, Andrasik F: A self-administered behavioral intervention using tailored messages for migraine. Headache 2005, 45:1124–1139.

    Article  PubMed  Google Scholar 

  43. Strom L, Petterson R, Anderson G: A controlled trial of self-help treatment of recurrent headache conducted via the Internet. J Consult Clin Psychol 2000, 68:722–727.

    Article  CAS  PubMed  Google Scholar 

  44. •• Lake AE III: Medication overuse headache: biobehavioral issues and solutions. Headache 2006, 46(Suppl 3):S88–S97. This article provides further information about how behavioral intervention can potentially improve treatment for medication overuse.

  45. Nash JM, Park ER, Walker BB, et al.: Cognitive-behavioral group treatment for disabling headache. Pain Med 2004, 5:178–186.

    Article  PubMed  Google Scholar 

  46. Peterlin BL, Tietjen GE, Brandes JL, et al.: Posttraumatic stress disorder in migraine. Headache 2009, 49:541–551.

    Article  PubMed  Google Scholar 

  47. Peterlin BL, Tietjen G, Meng S, et al.: Post-traumatic stress disorder in episodic and chronic migraine. Headache 2008, 48:517–522.

    Article  PubMed  Google Scholar 

  48. •• Tietjen GE, Brandes JL, Peterlin BL, et al.: Childhood maltreatment and migraine (part I). Prevalence and adult revictimization: a multicenter headache clinic survey. Headache 2009 Oct 21 (Epub ahead of print). This is the most comprehensive look at how prevalent childhood abuse is in persons presenting for headache treatment. It is likely that this issue will become even better understood over the next few years.

  49. • Tietjen GE, Brandes JL, Peterlin BL, et al.: Childhood maltreatment and migraine (part II). Emotional abuse as a risk factor for headache chronification. Headache 2009 Oct 21 (Epub ahead of print). Part II of the above article [48••] also helps to better understand the potential impact of abuse on headache.

Download references

Disclosure

Dr. Robert A. Nicholson serves on the speakers’ bureau for Ortho-McNeill Pediatrics, and has been involved in research funded by Merck & Co., Inc. and Endo Pharmaceuticals. This manuscript was prepared while Dr. Nicholson was funded by the National Institutes of Health (NS048288).

Author information

Authors and Affiliations

  1. Department of Neurology & Psychiatry, Saint Louis University School of Medicine, Monteleone Hall, 1438 S. Grand Blvd., St. Louis, MO, 63104, USA

    Robert A. Nicholson

  2. Ryan Headache Center/Mercy Health Research, 12680 Olive Boulevard, Suite 200, St. Louis, MO, 63141, USA

    Robert A. Nicholson

Authors
  1. Robert A. Nicholson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert A. Nicholson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nicholson, R.A. Chronic Headache: The Role of the Psychologist. Curr Pain Headache Rep 14, 47–54 (2010). https://doi.org/10.1007/s11916-009-0087-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-009-0087-9

Keywords

Search

Navigation