Critical issues in the assessment of headache

In an earlier paper, Thompson (1982) made the point that "an adequate assessment and understanding of the relevant independent and dependent variables related to subjects' headache complaints will yield information pointing to the most logical choice for a treatment intervention" (p. 230). It is essential that researchers and clinicians adopt an idiographic approach if we are to fully realize the potential of biofeedback, behavior therapy, and other nonpharmacological approaches as primary or ancillary interventions in the management of head pain. Large group comparisons, composed of heterogeneous subject populations treated with standardized techniques, have failed to elucidate the optimal intervention for individualized headache complaints. Yates (1980) noted with reference to biofeedback. "The reason for the failure of biofeedback training to show any consistent superiority over other relaxation training techniques stems from its use as a blunderbuss rather than as a rapier or precision instrument" (p. 499). We would maintain that a similar situation has pervaded the headache literature with a "blunderbuss" approach characterizing assessment and client-treatment-matching strategies. The remediation of the current controversy regarding treatment efficacy in the area of head pain is dependent upon the careful and critical use of assessment strategies in future research and clinical activity.