Psychological factors and headache

Introduction
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By Ronald S Kaiser PhD, Sarah M Gomez MD, and Angela L Borsuk PsyD

Psychological factors and their role in headache have been known for centuries and possibly millennia. In the past, it was believed that headache was caused by psychological factors; however, it is now recognized that headache is a complex biomedical disorder in which psychological factors can play a contributory, maintainance, and/or reactive role. In this clinical article, Dr. Ronald Kaiser of Thomas Jefferson University, Michelle Petrongolo of the Philadelpha College of Osteopathic Medicine, and Susan McCrea of the Widener University Institute for Graduate Clinical Psychology describe the interaction of psychophysiological factors with headache syndromes, the evidence for genetic and environmental factors, and novel forms of nonpharmacologic therapies for the headache patient with psychological accompaniments. This review highlights new research identifying the role of abuse histories in headache as well as the significant impact of headache on patient quality of life.

Key points

  • Although headache is almost always a biochemical disorder, psychological factors often play a contributory role in headache onset and/or a reactive role in headache maintenance.
  • There is a high level of comorbidity between headache and psychiatric disorders such as depression and anxiety.
  • Because headache has a major impact on quality of life, psychological interventions such as psychotherapy and biofeedback are not only useful adjuncts to medication therapy, but also permit patients to be actively involved in managing their lifestyles.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
References cited
Contributors