A biobehavioral approach to headache management.

Effective long-term management of patients with headaches can be challenging because these disorders are complex with heterogeneous triggers, expression, and impact.1,2 While the biomedical model has led to important discoveries in the pathophysiological mechanisms of headache, the model has limitations, including the marked varied individual responses to identical treatments.1 Headache has both sensory (e.g., pain location, intensity, and quality) and affective (e.g., depression, anxiety, distress) components.3 The pain experience involves the interconnectivity of physical vulnerabilities (e.g., genetics), psychological predispositions (e.g., prior learning history), biological changes, psychological issues, and biopsychosocial contexts that influence an individual’s evaluation of and response to headache.1 As a result, effective treatment of headache cannot rely solely on regulating the chemical and electrical signals within the pain pathways associated with headache, but must also address their cognitive, affective, and behavioral components. Typically, nonpharmacologic treatment for headache has been considered an option when the patient’s presentation fell outside the normative patient experience. As headache has begun to be conceptualized as a chronic disease,4 treatment also needs to reflect this conceptualization. Hence, a comprehensive, multidisciplinary treatment program to prevent headache is appropriate. The biobehavioral approaches with the strongest efficacy include cognitive behavioral therapy [CBT], relaxation training, biofeedback, and stress management.