Future directions in behavioral headache research: applications for an evolving health care environment.

Three decades of research has produced effective behavioral treatments for migraine and tension-type headache, yet the full fruition of this research has not been realized. Further development and dissemination of behavioral treatments is needed to impact the large numbers of those with headache who potentially could benefit from these interventions. At the same time, an evolving health care environment challenges researchers and providers to employ greater efficiency and innovation in managing all chronic disorders.

Moderators and mediators of behavioral treatment for headache.

Although work has been done establishing the efficacy of behavioral treatments for headache, almost no work has been done using appropriate methodology to evaluate what types of patients in which settings (termed "moderators") are likely to benefit from treatment and what treatment components account for treatment response (termed "mediators"). The current article provides an overview of moderators and mediators and their assessment and analysis as they pertain to clinical trials. The article also discusses the need for moderator and mediator hypotheses to be theory driven.

Behavioral headache research: methodologic considerations and research design alternatives.

Behavioral headache treatments have garnered solid empirical support in recent years, but there is substantial opportunity to strengthen the next generation of studies with improved methods and consistency across studies. Recently, Guidelines for Trials of Behavioral Treatments for Recurrent Headache were published to facilitate the production of high-quality research. The present article compliments the guidelines with a discussion of methodologic and research design considerations.

Pain state as artifact in the psychological assessment of recurrent headache sufferers.

The finding that recurrent headache sufferers, particularly tension headache sufferers, obtain higher scores on psychological symptoms measures than controls was replicated in 262 recurrent (tension, mixed, and migraine) headache sufferers and 26 controls. However, closer examination of the data revealed that psychological symptoms were elevated only in patients who experienced head pain at the time of assessment. This finding raises the possibility that previously reported elevations in psychological symptoms have resulted from uncontrolled differences in the pain state of respondents.