[PSYCHO-MEDICAL ASPECTS OF PRIMARY HEADACHES]

Primary headaches such as migraine and tension type headaches are extremely common and present a significant clinical challenge. These conditions involve a complex interaction between biological and psychological processes. As part of a "vicious cycle" effect, primary headaches can be deleterious to patients, causing stress, anxiety and catastrophization, while at the same time becoming exacerbated by those very same cognitive and emotional states.

Medications often have a limited effect in treating chronic primary headache. Additionally, there are a number of sub-populations for whom many common medications are contraindicated, such as: pregnant women, patients with sensitivities to medication and patients in danger of medication overuse. Mind-body therapies for reducing stress, such as relaxation training and biofeedback, as well as cognitive and behavioral therapies have been used to treat primary headache for the better part of the last four decades. These treatments have been shown to be efficacious in reducing symptoms as well as in improving patient functioning and quality of life. Treatment effects have been shown to continue even after termination of therapy, as patients are given tools to regulate their sympathetic arousal and taught to adopt more constructive coping behaviors and thought processes regarding their condition. Despite the plethora of studies demonstrating the effectiveness of mind-body and cognitive-behavioral therapies and despite recommendations made by various consensus groups, these therapies remain under-used in routine medical practice.

In order to address this problem we propose a graded, integrative model currently being implemented in the "Functional Neurology Clinic" at 'Soroka' University Medical Center. This model contains a three-step treatment algorithm for quickly and effectively teaching patients self-relaxation techniques. The model is meant to be used in conjunction with pharmacological treatments for primary headaches and can be used in inpatient hospitalization, outpatient clinics or multi-disciplinary treatment centers.