Psychological Interventions for Headache That Has Become Difficult to Treat

  • Donna Maria Coleston-Shields
Reference work entry


While it may be argued that all headache patients could benefit from psychological pain management of some form, restricted access to psychology services or prohibitive waiting lists may mean that the headache clinician has to focus psychological efforts only when psychological difficulties are suspected and these factors may be making the headache harder to treat. An association between headache, migraine in particular, and depression has long been described. The task is to recognize and formally describe low mood and increased anxiety (using basic standardized assessments), and then to interpret such symptoms appropriately: do they represent a primary psychological disorder (clinical depression or anxiety) or are they instead a consequence of the experience of head pain? Especially if the former is the case, referral on to specialist psychology services may be necessary, but it may be possible for the headache clinician to recommend or make use of some basic psychological techniques, particularly those involving relaxation training, which when learned properly and used regularly can be impressively effective.


Chronic Daily Headache General Health Questionnaire Headache Clinician Beck Anxiety Inventory Hospital Anxiety Depression Scale 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Andrasik F, Blanchard EB, Arena JG, Teders SJ, Teevan RC, Rodichock LD (1982) Psychological functioning in headache sufferers. Psychosom Med 44(2):171–182PubMedGoogle Scholar
  2. Baskin SM, Weeks RE (2003) The biobehavioral treatment of headache. In: Moss D, McGrady A, Davies T, Wickramasekera I (eds) Handbook of mind-body medicine in primary care. Sage, Thousand Oaks, pp 205–222Google Scholar
  3. Beck AT (1990) Beck anxiety inventory. The psychological corporation. Harcourt Brace & Company, San AntonioGoogle Scholar
  4. Beck AT (1993) Cognitive therapy and the emotional disorders. Penguin, New YorkGoogle Scholar
  5. Beck AT (1996) Beck depression inventory II. The psychological corporation. Harcourt Brace & Company, San AntonioGoogle Scholar
  6. Carver CS (1997) You want to measure coping but your protocol's too long: consider the Brief COPE. Int J Behav Med 4(1):92–100PubMedCrossRefGoogle Scholar
  7. Carver CS, Scheier MF, Weintraub JK (1989) Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol 56:267–283PubMedCrossRefGoogle Scholar
  8. Daly EJ, Donn PA, Galliher MJ, Zimmerman JS (1983) Biofeedback applications to migraine and tension headache: a double-blinded outcome study. Biofeedback Self Regul 8:135–152PubMedCrossRefGoogle Scholar
  9. De Fidio D, Sciruicchio V, Pastore B, Prudenzano MP, Di Pietro E, Tramontano A, Lorizio A, Granella F, Bussone G, Grazzi L, Sarchielli P (2000) Chronic daily headache: personality study by means of computerized MMPI-2. J Headache Pain 1(1):S67–S70CrossRefGoogle Scholar
  10. Duckro PN, Richardson WD, Marshall JE, Cassabaum S, Marshall G (1999) Taking control of your headaches: how to get the treatment you need. Guilford, New YorkGoogle Scholar
  11. Eisenbud J (1937) The psychology of headache: a case studied experimentally. Psychiatr Quart 11(4):592–619CrossRefGoogle Scholar
  12. Franchini L, Bongiorno F, Dotoli D, Rainero I, Pinessi L, Smeraldi E (2004) Migraine headache and mood disorders: a descriptive study in an outpatient psychiatric population. J Affect Disord 81(2):157–160PubMedCrossRefGoogle Scholar
  13. Fulbright RK, Troche CJ, Skudlarski P, Gore JC, Wexler BE (2001) Functional MR imaging of regional brain activation associated with the affective experience of pain. Am J Roentgenol 177:1205–1210Google Scholar
  14. Goldberg D (1981) The general health questionnaire. NFER-Nelson Publishing Company Ltd, WindsorGoogle Scholar
  15. Harvey PG, Hay KM (1984) Mood and migraine – a preliminary prospective study. Headache 24(2):225–228PubMedCrossRefGoogle Scholar
  16. Holroyd KA, Drew JB (2006) Behavioral approaches to the treatment of migraine. Semin Neurol 26:199–207PubMedCrossRefGoogle Scholar
  17. Holroyd KA, O'Donnell FJ, Stensland M, Lipchick GL, Cordingley GE, Carlson BW (2001) Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. J Am Med Assoc 285:2208–2215CrossRefGoogle Scholar
  18. Holroyd KA, Martin PR, Nash JM (2005) Psychological treatments of tension-type headache. In: Olesen J, Goadsby PJ, Ramadan N, Tfelt-Hansen P, Welch KM (eds) The headaches. Lippincott Williams & Wilkins, Philadelphia, pp 711–719Google Scholar
  19. Jenkinson C (1990) Health status and mood state in a migraine sample. Int J Soc Psychiatry 36(1):42–48PubMedCrossRefGoogle Scholar
  20. Kaji Y, Hirata K (2009) Characteristics of mood disorders in Japanese patients with medication-overuse headache. Intern Med (Japan) 48(12):981–986Google Scholar
  21. Kang EH, Park JE, Chung CS, Yu BH (2009) Effect of biofeedback-assisted autogenic training on headache activity and mood states in Korean female migraine patients. J Korean Med Sci 24(5):936–940PubMedCrossRefGoogle Scholar
  22. Kaushik R, Kaushik RM, Mahajan SK, Rajesh V (2005) Biofeedback assisted diaphragmatic breathing and systematic relaxation versus propanolol in long term prophylaxis of migraine. Complement Ther Med 13:165–174PubMedCrossRefGoogle Scholar
  23. Kuchemann C, Sanders D (2007) Understanding health anxiety: a self-help guide for sufferers and their families. Oxford University Press, OxfordGoogle Scholar
  24. Lucas C, Lanteri-Minet M, Massiou H, Nachit-Ouinekh F, Pradalier A, Mercier F, El Hasnaoui A, Radat F (2007) The GRIM2005 study of migraine consultation in France II. Psychological factors associated with treatment response to acute headache therapy and satisfaction in migraine. Cephalalgia 27(12):1398–1407PubMedCrossRefGoogle Scholar
  25. MacGregor A, Jensen R (2008) Migraine and other primary headaches. Oxford University Press, OxfordCrossRefGoogle Scholar
  26. Marino E, Fanny B, Lorenzi C, Pirovano A, Franchini L, Colombo C, Bramanti P, Smeraldi E (2009) Genetic bases of comorbidity between mood disorders and migraine: possible role of serotonin transporter gene. Neurol Sci (Italia) 1:1590–1874Google Scholar
  27. Mérelle SYM, Sorbi MJ, van Doornen LJP, Passchier J (2008a) Migraine patients as trainers of their fellow patients in non-pharmacological preventative attack management: short-term effects of a randomized controlled trial. Cephalalgia 28:127–138PubMedGoogle Scholar
  28. Mérelle SYM, Sorbi MJ, van Doornen LJP, Passchier J (2008b) Lay trainers with migraine for a home-based behavioural training: a 6-month follow-up study. Headache 48:1311–1325PubMedCrossRefGoogle Scholar
  29. Merskey H (1992) Migraine and mood. Cephalalgia 12(2):68PubMedGoogle Scholar
  30. Nideffer RM (1979) ACT attention control training: how to get control of your mind through total concentration. Wideview Books, New YorkGoogle Scholar
  31. Prohaska TR, Leventhal EA, Leventhal H, Keller ML (1985) Health practices and illness cognition in young, middle aged, and elderly adults. J Gerontol 40:569–578PubMedGoogle Scholar
  32. Pryse-Phillips WEM, Dodick DW, Edmeads JG, Gawel MJ, Nelson RF, Purdy RA, Robinson G, Stirling D, Worthington I (1998) Guidelines for the nonpharmacologic management of migraine in clinical practice. Can Med Assoc J 159(1):47–54Google Scholar
  33. Richards JS, Nepomuceno C, Riles M, Suer Z (1982) Assessing pain behavior: the UAB Pain Behavior Scale. Pain 14(4):393–398PubMedCrossRefGoogle Scholar
  34. Sargent JD, Green EE, Walters ED (1972) The use of autogenic feedback training in a pilot study of migraine and tension headaches. Headache 12:120–124PubMedCrossRefGoogle Scholar
  35. Sargent JD, Walters ED, Green EE (1973) Psychosomatic self-regulation of migraine headaches. Semin Psychiatry 5:415–427PubMedGoogle Scholar
  36. Schnider P, Maly J, Mraz M, Brantner Inthaler S, Zeiler K, Wessely P (1995) MMPI and critical flicker frequency (CFF) analysis in headache patients with and without drug abuse. Headache 35(1):17–20PubMedCrossRefGoogle Scholar
  37. Sorbi MJ, van der Vaart R (2010) User acceptance of an Internet training aid for migraine self-management. J Telemed Telecare 16(1):20–24PubMedCrossRefGoogle Scholar
  38. Usai S, Grazzi L, D’Amico D, Andrasik F, Bussone G (2009) Psychological variables in chronic migraine with medication overuse before and after inpatient withdrawal: results at 1-year follow-up. Neurol Sci (Italia) 30(Suppl 1):S125–S127, 1590–1874Google Scholar
  39. Vilming ST, Ellertsen B, Troland K, Schrader H, Monstad I (1997) MMPI profiles in post-lumbar puncture headache. Acta Neurol Scand 95(3):184–188PubMedCrossRefGoogle Scholar
  40. Voils CI, Steffens DC, Flint EP, Bosworth HB (2005) Social support and locus of control as predictors of adherence to antidepressant medication in an elderly population. Am J Geriatr Psychiatry 13(2):157–165PubMedGoogle Scholar
  41. Wall P (1999) Pain: the science of suffering. Weidenfeld & Nicolson, LondonGoogle Scholar
  42. Wallston KA, Wallston BS, DeVellis R (1978) Development of the Multidimensional Health Locus of Control (MHLC) scales. Health Educ Monogr 6:160–170PubMedGoogle Scholar
  43. Warner G, Lance JW (1975) Relaxation therapy in migraine and chronic tension headache. Med J Aust 1:298–301PubMedGoogle Scholar
  44. Young JE (1999) Cognitive therapy for personality disorders: a schema-focused approach. Professional Resource Press, FloridaGoogle Scholar
  45. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedCrossRefGoogle Scholar
  46. Zsombok T, Juhasz G, Budavari A, Vitrai J, Bagdy G (2003) Effects of autogenic training on drug consumption in patients with primary headache: an 8-month follow-up study. Headache 43:251–257PubMedCrossRefGoogle Scholar

Copyright information

© Lifting The Burden 2011

Authors and Affiliations

  1. 1.Department of NeuropsychologyNeurosciences Unit, University Hospital Coventry & WarwickshireCoventryUK

Personalised recommendations