Handbook of Psychology

CHAPTER 11

Headaches

FRANK ANDRASIK AND SUSAN E. WALCH

245

HEADACHE CLASSIFICATION
AND DIAGNOSIS 245
MEASUREMENT OF HEADACHE PAIN 249
Headache Diary 249
Supplementary Approaches 250
HEADACHE TREATMENT 250
Pharmacological Treatment 250
Nonpharmacological Treatments for Headache 252
BEHAVIORAL TREATMENT 253
A Biobehavioral Model of Headache 253
Implementation 254

Headache is a clinical syndrome affecting over 90% of the
population at some time during their life, resulting in it being
considered a major public health issue (Mannix, 2001). It is
the seventh leading presenting complaint in ambulatory care
in the United States, accounting for about 18 million of“ce
visits a year (Barrett, 1996). The impact of headache is
considerable. For example, it accounts for over 100 million
bedridden days per year, costs U.S. employers over $13 bil-
lion per year, and signi“cantly decreases quality of life, much
more so than many other chronic illnesses (Mannix, 2001).
Although most headaches are relatively benign, for 1% to 3%
of patients the etiology can be life-threatening (Evans, 2001).
Consequently, nonphysician practitioners are urged to refer
all headache patients to a physician who is experienced with
evaluating headache and then to maintain a close collabora-
tion during treatment as necessary. Even after arranging a
medical evaluation, the nonphysician therapist must be con-
tinually alert for evidence of a developing underlying physi-
cal problem. Table 11.1 lists some •danger signsŽ that may
suggest a need for immediate referral to a physician.
This chapter focuses chie”y on the two headache types
most likely to be seen by nonmedical practitioners„
migraine, experienced by about 18% of females and 7%
of males, and tension-type headache, experienced by about
40% of the population (Mannix, 2001), but provides brief
attention to other forms of headache likely to be encountered

in practice. We “rst address classi“cation and diagnosis, as

well as pertinent measurement issues. The remainder of the

chapter is devoted to treatment, both pharmacological and

behavioral. Behavioral treatment begins with a brief

overview of the biobehavioral model of headache. It then

focuses on the most common approaches (relaxation,

biofeedback, and cognitive behavioral therapy) and factors to

consider when planning and administering treatment. The

chapter closes with a brief summary and identi“cation of di-

rections for further study.

HEADACHE CLASSIFICATION AND DIAGNOSIS

Classi“cation and diagnosis are important for guiding treat-

ment (particularly medical), identifying subtypes that present

special challenges or that should be referred for care else-

where, and characterizing client samples clearly for research

investigations (one of the ef“cacy criteria established by the

initial task force on empirically validated/supported treat-

ments) (Task Force on Promotion and Dissemination of Psy-

chological Procedures, 1995).

In 1985, the International Headache Society (IHS) assem-

bled headache experts from around the world to enumerate

the various types and subtypes of headache and to develop

explicit inclusion and exclusion diagnostic criteria (as the

BEHAVIORAL TREATMENT PLANNING 257

Headache Type, Frequency, and Chronicity 258

Age and Gender 258

Treatment History 258

Comorbid Psychological Distress or Disorder 259

Environmental Factors 259

Patient Preference and Cost Effectiveness 260

Treatment Algorithms 260

Treatment Format and Delivery 260

SUMMARY AND FUTURE DIRECTIONS 261

REFERENCES 262