Psychology and Headaches

Headache is the most common pain disorder among children and adolescents. The following psychological approaches have been proven effective components of treatment for both tension and migraine headaches. The best-proven treatment approaches include:

Relaxation/self-hypnosis – There are a number of behavioral and cognitive-behavioral strategies that are classified as relaxation techniques. Children initially work with a psychologist or other trained professional to learn such techniques, but once they have mastered these skills, children can use them on their own to help reduce or prevent painful episodes
- Deep Breathing – Slow, deep breathing can promote generalized relaxation, which can help to dilate constricted blood vessels and reduce muscle tension that contributes to headache pain.
- Progressive Muscle Relaxation – Typically these techniques involve tensing and then releasing large muscle groups throughout the body to heighten awareness of the tension-free state. Children can improve their ability to recognize and reduce muscle tension.
- Guided Imagery – Imagery is a cognitive (i.e., brain-based) technique in which children are coached to imagine a pleasant or happy scene that is inconsistent with feelings of tension and pain. The person guiding the imagery encourages the child to use all his or her senses to develop a vivid image involving sights, sounds, tastes, smells and other sensations. Imagery has been shown not only to distract the child from pain but also to reduce the perception of pain by eliciting descending signals from the brain that can help to block pain signals.
- Self-Hypnosis – Hypnosis is a narrowing of attention or consciousness that can counteract stress and pain. In self-hypnosis, the child learns to focus concentration and reduce energy expenditure. Deep breathing, muscle relaxation, and often imagery are incorporated into this self-guided relaxation technique.

Biofeedback – Biofeedback uses electronic equipment to monitor and "feed back" information about body functions, such as breathing, skin temperature, muscle tension and heart rate. Although these functions typically operate outside a child's immediate awareness or control, children can gain voluntary control over these functions and use them to promote relaxation and pain control. Both thermal biofeedback (i.e., learning to increase skin temperature in the extremities) and EMG biofeedback (learning to reduce muscle tension, particularly in the frontalis muscles of the forehead) have been shown to be effective treatments for pediatric headache.

Other cognitive-behavioral and environmental interventions – Other approaches, such as contingency management (teaching parents to reinforce non-pain-related behaviors and to pay less attention to pain-related behaviors) or identifying and altering environmental and behavioral headache triggers, also can be effective treatments for pediatric headache patients.

Family interventions – Because chronic pain in a child can affect the entire family in many ways, it often is helpful for the family to meet with the psychologist. Together they can identify ways to respond differently to the child's pain and learn how they can be most helpful in encouraging the child to return to his or her previous level of functioning.