If you are one of the millions of people who suffer from chronic, painful headaches, you undoubtedly are well aware that headaches can generate feelings of frustration and despair and even cause depression. It's also known that anxiety and stress can trigger or aggravate certain types of chronic headaches, such as tension-type headaches.

Regardless of your headache type — migraine, tension, cluster, etc. — it's important for you to become a major player in your headache treatment.  Fortunately, there are ways to help you manage headaches and the emotional upheaval that can accompany them.  An integrated pain relief plan that includes medications, physical therapy and complementary therapies, such as biofeedback, massage and relaxation techniques, can provide not only relief from pain, but also empowerment. You, not your headaches, are in control of your life.  This, in turn, can ease the sense of helplessness that can lead to despair and depression.

Following are some ways to recognize and manage some of the psychological issues pertaining to certain types of headaches:

Tension-Type Headache

It's widely believed that anxiety and stress can trigger tension-type headaches.  For example, such headaches often are more pronounced in the afternoon and evening, when both stress and tension levels are higher.  A combination of physical and psychological factors can provoke tension and stress.  Say you're at work and have a project due by 5 p.m. You sit for hours in front of the computer screen, your muscles becoming tighter and your posture more rigid — a condition known as muscular bracing — as you concentrate on your work.  By 4 p.m., you have a full-blown headache. 

Learning how to interrupt muscular bracing can help you reduce or eliminate tension-type headache pain.  One way to break the cycle is to practice relaxation techniques that focus on your facial and back muscles and to make sure you take frequent breaks from the computer.  Set your watch alarm or computer timer to go off every 30 minutes and then get up, stretch and focus on relaxing tense muscles.  On a daily basis, try practicing other stress-reducing techniques such as meditation, breathing exercises and self-hypnosis to help you take control over anxious and worrisome thoughts that can lead to stress and trigger tension-type headaches.

Migraine Headache

By their very nature, migraine headaches can cause major disruptions in your life — both physically and emotionally.  They can occur anytime during the day or night, be aggravated by light, sound and smells and take days for the side effects to completely go away. No wonder, then, that many migraine headache sufferers feel depressed as well as disconnected from family, friends and co-workers.  As with all types of headaches, migraines require an integrated approach to treatment that may include medications, physical therapy and relaxation techniques.  In particular, self-hypnosis and EMG and thermal biofeedback may prove effective in reducing migraine headache symptoms. Along with abortive medications such as Imitrex that can halt migraine pain, finding ways to relax your body's autonomic or automatic nervous system is essential for long-term migraine headache control. Combining medication management with biofeedback and relaxation techniques has proven effective in the long-term control of headaches.

Cluster Headaches

The psychological dynamic of cluster headaches are much the same as that for migraines. Each of these extremely painful conditions can result in frustration, despair and depression.  As with migraine headaches, an integrated approach to pain treatment that includes medications, relaxation techniques and physical therapy works best to manage cluster headache pain.

As a headache patient you can gain control over your life by learning as much as you can about the disorder and treatment options. Not only is this information personally empowering, it will enable you to inform others — including health-care providers and insurers — about the disorder.  Approaching this condition from many angles — physically, psychologically and environmentally — is critical to effectively managing headaches.

Finding a Qualified Mental Health Professional

In terms of finding a qualified professional to help with emotional issues, mental health specialists vary considerably in their level of training and their experience in helping patients with pain. Here are some questions you can ask to find out a professional's qualifications in helping you with emotional problems that frequently accompany pain:

• Do you belong to a recognized professional pain society, such as the American Pain Society or the American Academy of Pain Medicine? This indicates a commitment to learning about pain.

If the mental health specialist is a psychiatrist (a medical doctor with special training in evaluating and treating emotional disorders):

• Do you have experience in consultation-liaison (medical) psychiatry, a sub-specialty dealing with the emotional problems that commonly occur with any chronic medical illness, including pain?
• Do you frequently consult with pain medicine specialists?
• (Better yet) are you Board Certified in Pain Medicine?

If a psychologist (a non-medical doctor with special training in emotions and their evaluation and treatment) or social worker (non-medical counselor):

• Do you have training in health psychology and/or behavioral medicine?
• Do you affiliate with professional organizations in these fields?
• Do you have experience in working closely with medical doctors?
• Do you have specific training and/or experience working in a Pain Center or with Pain Medicine physicians? You want to make sure that your provider is not isolated from multi-disciplinary treatment? 
• Do you have close affiliations with expert psychopharmacologists (psychiatrists with expertise in the medications used to treat emotional problems) who can prescribe medications skillfully when needed?
• Do you obtain consultations easily and frequently? Again, you want to make sure that your provider is not professionally isolated.
• Do you understand the role of physical therapy and medications in pain management?

Unfortunately, often there are no credentials that can help you distinguish among psychologists, psychiatrists, medical social workers and the numerous others who advertise themselves as chronic pain specialists.  In any case, it is best to obtain a referral from a qualified arthritis specialist who is knowledgeable about chronic pain issues, or a Pain Medicine doctor who may know the answers to many of the above mental health specialist prior to referring you for treatment. If the professional works in a recognized Pain Clinic, that is a good indication that he or she is knowledgeable about chronic pain issues and will be able to help you as part of the pain management team.