title: Behavioral self-management in an inpatient headache treatment unit: increasing adherence and relationship to changes in affective distress.
abstract: OBJECTIVE
  To evaluate prospectively the contribution of a psychological self-management program to the amelioration of headache-related distress of patients with intractable migraine treated in a comprehensive, multidisciplinary, inpatient program.
  
  
  BACKGROUND
  Previous research has shown the effectiveness of this overall inpatient program but did not examine the relationships between the use of relaxation and other headache-related behavioral factors.
  
  
  METHODS
  Data from 221 admissions to a Commission on Accreditation of Rehabilitation Facilities-accredited, nationally recognized, inpatient treatment unit were analyzed for the current study. On admission and on discharge (average length of stay, 12.9 days), subjects completed a 7-day retrospective, self-report questionnaire assessing health behavior compliance and emotional factors. The intervention consisted of intensive medical therapy in addition to cognitive-behavioral treatment delivered in a group setting.
  
  
  RESULTS
  Adherence increased significantly for relaxation practice and life-style modifications of diet, exercise, and sleep regulation for headache prevention (P<.00001). Beck Depression Inventory scores decreased significantly (P<.00001), and a greater decrease in depression by the end of the program was reported by subjects who practiced relaxation most compared with those who practiced relaxation least.
  
  
  CONCLUSIONS
  Low baseline adherence rates for health behavior increased significantly during the final week of inpatient treatment. Behavioral self-management variables, not headache reduction, were significantly associated with patients' reduction in affective distress.
authors.affiliation: Head Pain Treatment Unit at Chelsea Community Hospital, Michigan, USA.
authors.forename: F
authors.initials: F
authors.lastname: Hoodin
authors.forename: B J
authors.initials: BJ
authors.lastname: Brines
authors.forename: A E
authors.initials: AE
authors.lastname: Lake
authors.forename: J
authors.initials: J
authors.lastname: Wilson
authors.forename: J R
authors.initials: JR
authors.lastname: Saper
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000342:Affective Symptoms / Q000209:etiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008824:Michigan; D008881:Migraine Disorders / Q000150:complications / Q000628:therapy*; D009483:Neuropsychological Tests; D010349:Patient Compliance / Q000706:statistics & numerical data*; D015397:Program Evaluation / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012064:Relaxation Therapy / Q000706:statistics & numerical data; D012648:Self Care / Q000706:statistics & numerical data*; D013312:Stress, Physiological / Q000209:etiology / Q000517:prevention & control / Q000628:therapy