Headache
Psychology and Headache
By: Dawn A. Marcus, MD
Psychologists are an important part of the headache treatment team. Nearly half of all patients with chronic pain complaints, like headache, have problems with depression and anxiety. In most cases, these symptoms can be managed by the family health care provider. If mood problems interfere with daily activities or enjoying life, working with a psychologist may help minimize these symptoms.
Psychologists can teach headache sufferers some of the most effective techniques for reducing headaches. Psychological pain management techniques can help reduce muscle spasm and the number of pain messages sent by the brain. These techniques are effective for most people with chronic pain.
Relaxation training, biofeedback and stress management are among the many techniques taught by psychologists. Patients achieve the most benefit from these techniques when they receive some formal training from an experienced therapist. Pain improvement after using these techniques does not mean that the pain was “imaginary” or “psychological.” These techniques are not designed to treat serious psychological problems such as depression and anxiety.
Relaxation techniques are as effective in reducing headaches as standard headache prevention medications, but without the associated side effects. About 50% to 80% of headache sufferers motivated to learn these techniques experience relief.1 2 3 There are several ways to teach the brain relaxation skills; biofeedback is a specific type of relaxation technique.
In a recent study, benefits from six months of relaxation training with biofeedback versus propranolol were compared in 192 migraine sufferers.3 Headache frequency, duration and severity were each decreased by about half with either treatment--with neither treatment better than the other. After completing six months of treatment, the study participants were told to taper their propranolol and to stop practicing relaxation techniques. Headaches returned after discontinuing prevention treatment in only one in 10 participants who had been trained in relaxation techniques, compared with a return in headaches in four of every 10 patients treated with propranolol. This study showed that relaxation techniques provide long-term benefits without the need for daily practice after skills have been mastered.
Here are some examples of common relaxation techniques:
Stress is reported as a headache trigger by about three of every four people with primary headaches. The occurrence of life stressors is linked to both headache frequency and severity.4 Stress may also be an important factor in the development of new headache, with high work stress resulting in a 26% increased risk for developing new onset migraine.5
Stress management is designed to improve headaches by altering the body’s physiological response when encountering stress. Examples of helpful techniques include:
Stress management consisting of autogenic and cognitive therapies results in significantly decreased headache frequency and medication consumption in patients with migraine, tension-type or a mixed headache pattern.6 Furthermore, a comparison of eight weeks of treatment with stress management versus amitriptyline showed greater benefits with stress management.7 Moderate to marked reduction in headache occurred for 94% treated with stress management training compared with 69% treated with amitriptyline.
References
Psychologists can teach headache sufferers some of the most effective techniques for reducing headaches. Psychological pain management techniques can help reduce muscle spasm and the number of pain messages sent by the brain. These techniques are effective for most people with chronic pain.
Relaxation training, biofeedback and stress management are among the many techniques taught by psychologists. Patients achieve the most benefit from these techniques when they receive some formal training from an experienced therapist. Pain improvement after using these techniques does not mean that the pain was “imaginary” or “psychological.” These techniques are not designed to treat serious psychological problems such as depression and anxiety.
Relaxation and Biofeedback
Relaxation techniques are as effective in reducing headaches as standard headache prevention medications, but without the associated side effects. About 50% to 80% of headache sufferers motivated to learn these techniques experience relief.1 2 3 There are several ways to teach the brain relaxation skills; biofeedback is a specific type of relaxation technique.
In a recent study, benefits from six months of relaxation training with biofeedback versus propranolol were compared in 192 migraine sufferers.3 Headache frequency, duration and severity were each decreased by about half with either treatment--with neither treatment better than the other. After completing six months of treatment, the study participants were told to taper their propranolol and to stop practicing relaxation techniques. Headaches returned after discontinuing prevention treatment in only one in 10 participants who had been trained in relaxation techniques, compared with a return in headaches in four of every 10 patients treated with propranolol. This study showed that relaxation techniques provide long-term benefits without the need for daily practice after skills have been mastered.
Here are some examples of common relaxation techniques:
- Progressive muscle relaxation begins with sitting in a quiet room in a comfortable chair. Rest your hands in your lap and keep your legs uncrossed. Close your eyes and practice tensing different muscle groups, one at a time. Tense your arms, and then legs, abdomen, shoulders, neck, jaw, eyes and forehead. Hold the tension for 10 to 15 seconds, and then release. Focus on how you feel with your muscles tensed and relaxed. Practice this for 20 minutes at a time. Once you are familiar with this technique, you can monitor the tension in your muscles and compare your sensations to those felt during this exercise. If tension in your muscles feels high, practice relaxation skills.
- Cue-controlled relaxation is also done sitting comfortably in a chair with hands in your lap and legs uncrossed. Close your eyes and take a deep abdominal breath. Hold your breath for 10 seconds, and then exhale. Repeat the word “relax” as you exhale. Place one hand over your abdomen to feel your belly move in and out with each breath. Practice this for 15 minutes at a time. Once you have mastered this skill, you can use deep breathing to become fully relaxed quickly throughout the day, such as when sitting on the bus or in class.
- Biofeedback is a relaxation skill that can be helpful for people who have difficulty with the techniques listed above. Biofeedback uses your body’s physical reactions, like muscle spasm or skin temperature, to show your success in using relaxation techniques. One type of biofeedback involves measuring hand temperature. Hand temperature should increase a few degrees when your muscles and nervous system relax. Simply warming your hands without using relaxation techniques will not be helpful. An inexpensive finger thermometer and biofeedback audiotape may be obtained from Primary Care Network (1-800-769-7565).
Stress Management
Stress is reported as a headache trigger by about three of every four people with primary headaches. The occurrence of life stressors is linked to both headache frequency and severity.4 Stress may also be an important factor in the development of new headache, with high work stress resulting in a 26% increased risk for developing new onset migraine.5
Stress management is designed to improve headaches by altering the body’s physiological response when encountering stress. Examples of helpful techniques include:
- Autogenic training – changing the body’s physiological response to stress
- Cognitive restructuring – changing one’s thoughts about stress
- Distraction – minimizing focusing on stress
Stress management consisting of autogenic and cognitive therapies results in significantly decreased headache frequency and medication consumption in patients with migraine, tension-type or a mixed headache pattern.6 Furthermore, a comparison of eight weeks of treatment with stress management versus amitriptyline showed greater benefits with stress management.7 Moderate to marked reduction in headache occurred for 94% treated with stress management training compared with 69% treated with amitriptyline.
References
- Warner G, Lance JW. Relaxation therapy in migraine and chronic tension headache. Med J Australia 1975;1:298-301.
- Daly EJ, Donn PA, Galliher MJ, Zimmerman JS. Biofeedback applications to migraine and tension headache: a double-blinded outcome study. Biofeedback & Self-Regulation 1983;8:135-152.
- Kaushik R, Kaushik RM, Mahajan SK, Rajesh V. Biofeedback assisted diaphragmatic breathing and systematic relaxation versus propranolol in long term prophylaxis of migraine. Complement Ther Med 2005;13:165-174.
- Fernandez E, Sheffield J. Relative contributions of life events versus daily hassles to the frequency and intensity of headache. Headache 1996;36:595-602.
- Mäki K, Vahtera J, Virtanen M, et al. Work stress and new-onset migraine in a female employee population. Cephalalgia 2008;28:18-25.
- Zsombok T, Juhasz G, Budavari A, Vitrai J, Bagdy G. Effect of autogenic training on drug consumption in patients with primary headache: an 8-month follow-up study. Headache 2003;43:251-257.
- Cordingley G, Holrody K, Pingel J, Jerome A, Nash J. Amitriptyline versus stress management therapy in the prophylaxis of chronic tension headache. Headache 1990;30:300.