The purpose of this study was to compare the marital and family adjustment of headache patients and their spouses, before pain control treatment, to couples without chronic pain. Minuchin's (1978) family systems theory of psychosomatic illness was tested, using an adult sample. This sample consisted of 117 headache-patient-and-spouse couples and a control group of 108 married couples without chronic pain. A survey design was used with marital and family assessment instruments. Marital and family questionnaires were given to headache patients and their spouses before beginning treatment and were sent to couples without chronic pain. "Headache couples" reported greater differences in consensus, cohesion, affection, and sexual relationships than did control couples. Headache patients reporting greater marital adjustment were more likely to have continuous pain than those reporting less marital adjustment. Headache patients' pain per day correlated positively with greater family cohesion and adaptability. Headache patients' severity of pain correlated positively with greater marital affection. The spouses' marital cohesion, affection, and family cohesion and adaptability correlated positively with increased severity of patients' pain.

SYNOPSIS In certain refractory cases of headache, inpatient therapy in a headache treatment unit may prove beneficial. Strict criteria for admission to this unit have been developed. To ascertain the long‐term benefits of treatment, a survey was sent to 372 consecutive patients. A 41% response rate was achieved. Fifty‐four percent of the patients had a greater than 50% reduction in headache unit index at the time of the survey and 59.6% had a greater than 50% reduction in the corrected headache unit index. Approximately 10% of those responding to the survey had become and remained completely headache‐free. Medical management and non‐drug therapies such as biofeedback and dietary instruction were viewed as being the most important treatment modalities by the patients. Psychological modalities were of benefit to 72% of the patients and biofeedback was useful to 54% of the patients. These results prompt us to believe that the multidisciplinary inpatient treatment of headache is beneficial to the majority of patients whose headaches have been refractive to traditional outpatient treatment.

SYNOPSIS Psychological and psychiatric factors contributing to headache etiology and prevalence have been reported over the past four decades. While intrapsychic and environmental explanations have been offered, no conceptual models have been suggested which accommodate both perspectives. Proposing to remedy this deficit with the presentation of a new model, we outline a case study of what is termed the “concubine syndrome,” that is a diagnostic classification which serves to illustrate the interaction of personality traits and external stressors that contribute to a particular type of headache problem. Using an interactional model of conceptualizing and treating this disorder, a discernible improvement was noted in reduction of headache pain. Aside from presenting criteria for differential diagnosis, we recommend further research and clinical evaluations which consider using this approach to assessing and treatment of headache disorders.

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