As predicted, patients who were confident they could prevent and manage their headaches also believed that the factors influencing their headaches were potentially within their control. In addition, self-efficacy scores were positively associated with the use of positive psychological coping strategies to both prevent and manage headache episodes and negatively associated with anxiety. Multiple regression analyses revealed that headache severity, locus-of-control beliefs, and self-efficacy beliefs each explained independent variance in headache-related disability.
Chronic tension-type headache has a greater impact on individuals' lives than has generally been realized, with affective distress being an important correlate of impairment. If treatment is to remedy impairment in functioning, affective distress, as well as pain, thus needs to be addressed.
Primary outcome measures failed to demonstrate a significant effect for topiramate over placebo; however, high dropout rate in the treatment group prohibits definitive conclusions about the efficacy of topiramate in this population.
In times of labour market insecurity and retrenchment of state support, low income families rely on friends and relatives as a safety net. This article explores the enhanced role of this ‘third source of welfare’ in light of these developments. It draws on qualitative longitudinal research to demonstrate how families’ situations fluctuate over two years and the importance of social support networks in hard times and periods of crisis. The research illustrates how social support is not necessarily a stable structure that families facing insecurity can fall back on, but rather a variable resource, and fluid over time, as those who provide such support experience changing capabilities and needs. A policy challenge is to help reinforce and not undermine the conditions that enable valuable social support to be offered and sustained, while ensuring sufficient reliable state support to avoid families having no choice but to depend on this potentially fragile resource as a safety net.
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