Psychological Risk Factors in Headache

Abstract

Headache is a chronic disease that occurs with varying frequency and results in varying levels of disability. To date, the majority of research and clinical focus has been on the role of biological factors in headache and headache-related disability. However, reliance on a purely biomedical model of headache does not account for all aspects of headache and associated disability. Using a biopsychosocial framework, the current manuscript expands the view of what factors influence headache by considering the role psychological (i.e., cognitive and affective) factors have in the development, course, and consequences of headache. The manuscript initially reviews evidence showing that neural circuits responsible for cognitive-affective phenomena are highly interconnected with the circuitry responsible for headache pain. The manuscript then reviews the influence cognitions (locus of control and self-efficacy) and negative affect (depression, anxiety, and anger) have on the development of headache attacks, perception of headache pain, adherence to prescribed treatment, headache treatment outcome, and headache-related disability. The manuscript concludes with a discussion of the clinical implications of considering psychological factors when treating headache. Keywordsheadache; self-efficacy; locus of control; biopsychosocial; psychological; negative affect Headache is currently conceptualized as a chronic disorder with acute episodes of pain occurring intermittently lasting anywhere from minutes to days. For a significant number of patients, these attacks occur once a month or more and result in varied levels of disability. 1-4 Clinicians thus need to consider what factors influence the development, course, and severity of individual headache attacks and subsequent disability in order to minimize the frequency of attacks, reduce their severity, and limit their impact on functioning. To date, the overwhelming majority of research and clinical interest has focused on biological influences. These efforts have resulted in significant steps forward in the treatment and prevention of headache and its related disability; however, this research has also revealed that biological factors alone fail to account for all aspects of headache and disability. Psychological factors such as headache management locus of control and self-efficacy, and negative affect/emotional states can alter the likelihood of a headache attack being triggered, the perceived severity of headache pain, the impact headache has on functioning, and treatment prognosis. 5,6 Unfortunately, psychological factors are typically considered relevant only in cases where the patient presents

Dynamics of Changes in Self-Efficacy and Locus of Control Expectancies in the Behavioral and Drug Treatment of Severe Migraine

“…Psychological interventions have been postulated to increase internal and reduce chance headache locus of control [26,27]. To the best of our knowledge, no clear hypothesis has been offered about the effect of psychological treatments on medical professionals headache locus of control.…”

“…Locus of control is postulated to moderate changes in other outcome variables observed with psychological treatment, particularly self-efficacy [26,27]. However, the direction of this moderation is in dispute.…”

Anxiety disorders and migraine intractability and progression

“…Comprehensive models of migraine and other pain conditions must include a role for psychological factors such as patient beliefs and avoidance behaviors. Although the literature is much larger than can be reviewed extensively here, fear of pain, fear of anxietyrelated sensations (anxiety sensitivity), and unwarranted avoidance behaviors have all been implicated in the persistence of headache and chronic pain [35][36][37]. For years, constructs such as anxiety sensitivity and avoidance behaviors have been identifi ed as characteristic of anxiety disorders [ 38 , 39 ], suggesting that their importance in migraine may be more than coincidental.…”

Placebo and other psychological interactions in headache treatment

“…In return, negative effects can induce attacks, increase their intensity and the subsequent disability according to an individual ''anxiety sensitivity'' [70,71] (Table 1; Fig. 1).…”