Development of a measure of self-efficacy for acute headache medication adherence.

Acute medication adherence is essential to manage chronic, episodic disorders, including headache. This paper describes the development of a measure of acute medication self-efficacy for headache (AMSE-H). Phase 1: 14 AMSE-H items were generated through qualitative interviews with 21 patients and 15 clinical headache experts.

Behavioral migraine management modifies behavioral and cognitive coping in people with migraine.

Objective: This is a secondary analysis of a randomized clinical trial which aims to examine changes in cognitive and behavioral responses to migraine with cognitive behavioral treatment for migraine, preventive medication for migraine, and their combination, and the relationship between these changes and reductions in migraine-related disability.

Background: Cognitive behavioral treatment is thought to reduce migraine-related disability through modifying maladaptive cognitive and behavioral responses to migraine.

Methods: Two hundred thirty-two people with migraine who did not respond to 5 weeks of optimized acute therapy were randomized into a 2 (beta-blocker vs placebo) X 2 (behavioral migraine management [BMM] vs no BMM) treatment design.

Influence of family psychiatric and headache history on migraine-related health care utilization.

Objective: We sought to examine the relationship of family history of headache and family history of psychiatric disorders on self-reported health care utilization tendencies for migraine treatment.

Background: Familial aggregation of both migraine and depression has been well established in the literature. Family history of headache and psychiatric disorders could influence health care utilization tendencies for migraine.

Optimal use of acute headache medication: a qualitative examination of behaviors and barriers to their performance.

Objective: This study aims to qualitatively examine the behaviors required to optimally use acute headache medication and the barriers to successful performance of these behaviors.

Background: The efficacy of drug treatment is partly determined by medication adherence. The adherence literature has focused almost exclusively on the behaviors required to optimally use medications that are taken on a fixed schedule, as opposed to medications taken on an as needed basis to treat acute episodes of symptoms, such as headaches.

Psychiatric comorbidity and response to preventative therapy in the treatment of severe migraine trial.

Introduction: Mood and anxiety disorders are comorbid with migraine and commonly assumed to portend a poor response to preventive migraine therapies. However, there is little evidence to support this assumption.

Method: We examined impact of a mood and/or anxiety disorder diagnosis using American Psychiatric Association Diagnostic and Statistical Manual criteria on response to the three preventative migraine therapies evaluated in the Treatment of Severe Migraine trial (n = 177): β-blocker, behavioral migraine management, or behavioral migraine management +β-blocker.

Tricyclic antidepressants for migraine and tension-type headaches.

Are largely beneficial, but a lack of research leaves important clinical questions unanswered

Effect of preventive (beta blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial.

Objective: To determine if the addition of preventive drug treatment (β blocker), brief behavioural migraine management, or their combination improves the outcome of optimised acute treatment in the management of frequent migraine.

Design: Randomised placebo controlled trial over 16 months from July 2001 to November 2005.

Setting: Two outpatient sites in Ohio, USA.

Dynamics of changes in self-efficacy and locus of control expectancies in the behavioral and drug treatment of severe migraine.

Background: Modification of expectancies (headache self-efficacy and headache locus of control) is thought to be central to the success of psychological treatments for migraine.

Purpose: The purpose of this study is to examine expectancy changes with various combinations of Behavioral Migraine Management and migraine drug therapies.

Methods: Frequent migraine sufferers who failed to respond to 5 weeks of optimized acute migraine drug therapy were randomized to a 2 (Behavioral Migraine Management+, Behavioral Migraine Management-) × 2 (β-blocker, placebo) treatment design.

Do psychiatric comorbidities influence headache treatment outcomes? Results of a naturalistic longitudinal treatment study.

This study examined if the presence of one or more psychiatric disorders influences headache treatment outcomes in patients in headache specialty treatment centers. Using a naturalistic, longitudinal design, 223 patients receiving preventive therapy for headache disorders completed 30-day daily diaries that assessed headache days/month and severity at acute therapy baseline and 6-month evaluation and also provided data on headache disability and quality of life at acute therapy baseline, preventive therapy initiation, preventive therapy adjustment, and 6-month evaluation visits. Psychiatric diagnoses were determined using the Primary Care Evaluation for Mental Disorders (PRIME MDs).

Moderation and mediation in the psychological and drug treatment of chronic tension-type headache: the role of disorder severity and psychiatric comorbidity.

We evaluated two putative moderators of treatment outcome as well as the role of Headache Management Self-Efficacy (HMSE) in mediating treatment outcomes in the drug and non-drug treatment of chronic tension-type headache (CTTH). Subjects were 169 participants (M=38 yrs.; 77% female; M headache days/mo.

Race differences in adherence to headache treatment appointments in persons with headache disorders.

Purpose: This research characterized patterns and predictors of adherence to headache treatment appointments in patients presenting at headache specialty treatment clinics throughout Ohio.

Basic Procedures: Participants were 186 patients (118 white, 68 African Americans, 89% female) in headache treatment clinics in Cincinnati, Cleveland, Columbus and Toledo, OH. The study used a naturalistic longitudinal cohort design and assessed patients during four treatment visits (pretreatment, one-month follow-up, two-month follow-up and six-month follow-up).

Tension-type headache and psychiatric comorbidity.

Much of the contemporary literature on headache disorders focuses on migraine headaches, despite the fact that tension-type headache (TTH) is highly prevalent and can be as debilitating as migraines. This article reviews the current literature on prevalence rates of psychiatric disorders in TTH populations, psychologic factors associated with TTH, and psychiatric disorders and their relationships with treatment outcomes in TTH. Key conclusions of this review include 1) prevalence rates of TTH vary across clinical and population-based samples; 2) greater TTH chronicity is associated with increased affective distress; 3) Axis II personality disorders may play an important role in TTH prevalence rates and psychologic functioning but have been understudied to date; and 4) maladaptive coping is common in persons with TTH.

Basic principles and techniques of cognitive-behavioral therapies for comorbid psychiatric symptoms among headache patients.

Recent research on headache has focused on identifying the prevalence of psychiatric disorders in headache patients and discerning the impact of psychiatric comorbidity on treatment of headache. The presence of comorbid psychiatric disorders, especially anxiety and depression, in headache patients is now a well-documented phenomenon. Existing but limited empirical data suggest that psychiatric comorbidity exacerbates headache and negatively impacts treatment of headache.

Behavioral approaches to the treatment of migraine.

Behavioral interventions such as biofeedback training, relaxation training, and cognitive-behavior stress management therapy have been identified as efficacious treatments for migraine headache. These treatments, and the formats (clinic-based, limited-contact, and home-based) in which they are taught, are described in this article. Information about public health interventions (school, work, Internet, and mass media) is also briefly addressed.

A self-management program for adult asthma: part IV, Analysis of context and patient behaviors.

Patient behaviors performed in the self-management of asthma have been investigated by use of black box theory as a model for examining behavioral change. Consequently, the context within which patients learn and perform processes of self-management has been ignored. The purpose of the present study was to investigate contextual and behavioral elements that comprise the management of asthma attacks by a large number of adult patients.

Methodological issues in clinical trials of drug and behavior therapies.

Trials that compare drug and behavior therapies or evaluate combination therapy raise special methodological issues. This article reviews these methodological issues and, where possible, offers guidelines for addressing them. Sources of bias in the selection and recruitment of participants and in the measurement of treatment outcomes are discussed.

Guidelines for trials of behavioral treatments for recurrent headache, first edition: American Headache Society Behavioral Clinical Trials Workgroup.

Guidelines for design of clinical trials evaluating behavioral headache treatments were developed to facilitate production of quality research evaluating behavioral therapies for management of primary headache disorders. These guidelines were produced by a Workgroup of headache researchers under auspices of the American Headache Society. The guidelines are complementary to and modeled after guidelines for pharmacological trials published by the International Headache Society, but they address methodologic considerations unique to behavioral and other nonpharmacological treatments.

Depression increases onset of tension-type headache following laboratory stress.

The aim of this study is to examine the influence of depression on headache onset following laboratory stress and on psychophysiological variables associated with tension-type headaches (TTHs). Diagnostic interviews identified three groups: headache prone and depressed (HP/D, N = 13); headache prone not depressed (HP/ND, N = 22); and healthy controls (HC, N = 13). Ss completed a laboratory stress task.

Treating chronic tension-type headache not responding to amitriptyline hydrochloride with paroxetine hydrochloride: a pilot evaluation.

Context: In some individuals, chronic tension-type headache fails to respond to tricyclic antidepressant medications that often serve as first-line therapy.

Objective: To evaluate the clinical efficacy of paroxetine hydrochloride for chronic tension-type headache not responding to amitriptyline hydrochloride.

Design And Setting: Open-label trial of paroxetine conducted at 2 outpatient sites in Ohio.

Factors associated with migraine-related quality of life and disability in adolescents: a preliminary investigation.

Objectives: This study examined factors associated with impaired quality of life and functioning in a sample of treatment-seeking adolescent migraineurs. Subjects.-The 37 participants were 51.

American Headache Society members' assessment of headache diagnostic criteria.

Objective: We assessed the views of physicians interested in headache as to the diagnosis of the most commonly occurring and currently controversial headaches.

Background: The International Headache Society (IHS) classification system has received wide professional endorsement and considerable empirical support, but in the United States, their adoption by clinicians may be proceeding more slowly. Questions remain, including what diagnostic criteria for migraine and tension-type headache clinicians may continue to favor over those outlined by the IHS, to what extent is the "transformed migraine" diagnosis used in clinical practice, and how is analgesic rebound headache diagnosed with regard to the various quantitative measures of analgesic use.

Behavioral and psychologic aspects of the pathophysiology and management of tension-type headache.

Behavioral and psychologic factors in tension-type headache are reviewed with reference to pathophysiology, comorbid psychiatric disorders, headache triggers, and behavioral treatment, including the efficacy of behavioral treatments, brief minimal contact administration of behavioral treatment, therapeutic mechanisms underlying the effectiveness of behavioral treatments, and the integration of drug and behavioral treatments. Anxiety or depression may contribute to central sensitization that underlies frequent tension-type headaches. Excessive analgesic use, comorbid psychiatric disorders, or persistent unaddressed headache triggers may limit the effectiveness of headache treatment.

Assessment and psychological management of recurrent headache disorders.

This article updates earlier reviews of recurrent headache disorders published in 1982 and 1992, selectively reviewing research published since 1990. Current issues in assessment (headache diagnosis, psychophysiology, comorbid psychopathology, quality-of-life assessment, and new assessment technologies) and psychological treatment (efficacy, therapeutic mechanisms, treatment delivery, and integration with drug therapy) are addressed. The author emphasizes the need to adapt psychological treatments to the severity of the headache disorder and to developments in drug therapy.