Psychologic and behavioral management of tension-type headache: treatment procedures

Abstract

Used as an adjunct or alternative to medication treatment, psychologic and behavioral approaches to tension-type headache decrease headache frequency, affective distress, and headache-related disability. These approaches directly address the psychologic and behavioral factors that contribute to the disorder and to the individual headache episodes. There is well-established evidence of efficacy for the three broad approaches: relaxation training, electromyographic biofeedback training, and cognitive-behavioral stress management. Treatment has been difficult to access, with most care provided by behavioral specialists in tertiary care settings using clinic-based or home-based treatment protocols. Recent attempts to make treatment more accessible to a wider range of tension-type headache sufferers include using medical personnel to deliver treatment from physician practices and using existing and emerging technologies to provide care in a purely self-administered format without face-to-face contact with therapists. These attempts are promising, but remain preliminary; therefore, there is a need for further development and testing.

Headache management for the pain specialist

“…There is well-established evidence for the efficacy of these treatment modalities in TTH [51]. Used either as an adjunct or an alternative to pharmacologic treatment, they reduce headache frequency, affective distress and headache-related disability.…”

Headache management for the pain specialist

“…Well-established evidence supports the efficacy of these treatment modalities in TTH. 51 Used either as an adjunct or an alternative to pharmacologic treatment, they reduce headache frequency, affective distress, and headache-related disability. These treatments are particularly appealing to patients who do not tolerate, do not respond to, or have a contraindication to drug treatment.…”

Behavioural management of migraine

“…Standard behavioural interventions may provide a 40-60% reduction in distress in an average individual with headache[4041] but those people with disabling levels of headache require an enhanced treatment package that addresses psychological, social and biological factors. [404243]…”