Psychosocial interventions in the management of recurrent headache disorders are reviewed from Ohio University, Athens, OH, and University of Mississippi Medical Center, Jackson, MS.
Psychosocial interventions in the management of recurrent headache disorders are reviewed from Ohio University, Athens, OH, and University of Mississippi Medical Center, Jackson, MS. The most frequently used interventions in adult patients are: 1) relaxation training, 2) biofeedback, 3) stress-management (cognitive-behavioral) therapy, and 4) dietary modification. Three types of relaxation training are employed: a) progressive muscle relaxation-alternately tensing and relaxing selected muscle groups, b) autogenic training-use of self-instructions of warmth and heaviness to promote relaxation, and c) meditation - use of a silently repeated word or sound to promote mental relaxation. Cognitive-behavioral interventions teach patients to identify stressful precipitants and strategies for coping with stress. Behavioral interventions yielded outcomes roughly equivalent to those obtained with propanolol in 60 clinical trials and 2400 patients with migraine. More than 50% improvement was obtained with either relaxation/biofeedback training or propanolol, compared to 14% with placebo and 3% if untreated. [
COMMENT. The management of headache in children is different from that of adults and requires an assessment of cognitive and affective development and a knowledge of children’s concepts of illness and pain. The use of long-term investigational medications in children is often undesirable and relaxation techniques and dietary modification may be more effective and appropriate. (