Cognitive Behavioral Treatment of Chronic Headache

SYNOPSIS A cognitive behavioral treatment study based on 45 chronic headache patients is presented. The sample included patients who had been diagnosed as suffering from muscle contraction, migraine or combined muscle contraction‐migraine headaches. The treatment procedure followed Meichenbaum's cognitive theory of self‐control and had, as its theoretical basis, a psychobiological model of headache. Patients were given individual training in the use of behavioral and cognitive techniques which were designed to modify the sensations, thoughts, and feelings identified by the patients as forming part of their headache syndrome. Treatment effectiveness was examined in relation to a number of topographical characteristics of each patient's headache pattern. The topographical data were collected with a self‐observation record which provided information with respect to: duration of attacks, intensity of pain, time of onset, proportion of attacks associated with various head pain locations, presence of associated headache symptoms and medication usage. The results showed a significant overall treatment effect that was maintained at 6‐month follow‐up. An analysis of covariance revealed that the treatment gains were similar across diagnostic groups. Treatment gains were also found to be largely independent of the headache parameters obtained from the self‐observation record. Head pain locations and symptoms thought to be diagnostic of migraine and muscle contraction headache were not predictive of response to treatment. However, it was observed that headache patients who experienced continuous or near‐continuous pain during their waking hours were not responsive to the treatment procedure. The significance of these findings for the behavioral management of headache is discussed along with their significance for understanding the psychobiological processes controlling chronic headache. The authors wish to express their gratitude to Merleen Hodgson for her contributions to this project.