Psychologic and behavioral aspects of chronic headache

It is important for physicians to be aware of the expectations and psychologic needs patients have, to understand how psychologic and personality variables can impact care, to realize the importance of patient education, and to be cognizant of how environmental factors can influence headache pain behaviors. Empirical data indicate that the nonpharmacologic treatments of biofeedback, relaxation, and stress coping training can serve as useful adjunctive or alternative procedures, and that the combined use of medication and nonpharmacologic treatments yields the greatest clinical outcome. Certain headache types show minimal response to nondrug therapies alone (cluster, menstrual, and post-traumatic headache). Age and personality variables have a bearing on nondrug treatment outcome as well.