title: Psychophysiologic Therapy for Chronic Headache in Primary Care.
abstract: BACKGROUND: Headaches account for a high percentage of office visits to primary care physicians, with migraine and tension-type headaches the most common. This article provides a summary of psychophysiologic therapies for migraine and tension-type headache and considers psychosocial factors relevant to headache. Psychophysiologic therapy of headache consists primarily of relaxation and biofeedback. METHOD: Representative controlled studies, meta-analysis, and reviews are utilized to assess the efficacy of biofeedback and relaxation for migraine and tension-type headache. RESULTS: Psychophysiologic therapy comprising biofeedback and relaxation can be provided in standard or limited therapist contact formulas to patients as sole therapy or concurrently with medical therapy. Effectiveness has been demonstrated for thermal biofeedback-and electromyograph biofeedback-assisted relaxation with minimal or no side effects. A typical treatment protocol is offered to exemplify the integration of psychophysiologic therapy into primary care practice. CONCLUSION: Psychophysiologic therapy represents an important adjunctive treatment for chronic benign headache that can be incorporated into primary care.
authors.affiliation: Departments of Psychiatry and Medicine, Medical College of Ohio, Toledo; Behavioral Medicine Laboratory, University of West Florida, Pensacola; the Department of Family Medicine, Eastern Virginia Medical School, Norfolk; the Center for Persons With Disabilities, Utah State University, Logan; the Saybrook Institute, San Francisco, and the Complementary Medicine Clinic, Stanford Medical School, Hercules, Calif.; the New England Institute of Behavioral Medicine, Stamford, Conn.; and the Department of Psychiatry, University of Mississippi Medical Center, Jackson.
authors.forename: Angele V.
authors.initials: AV
authors.lastname: McGrady
authors.forename: Frank
authors.initials: F
authors.lastname: Andrasik
authors.forename: Terrence
authors.initials: T
authors.lastname: Davies
authors.forename: Sebastian
authors.initials: S
authors.lastname: Striefel
authors.forename: Ian
authors.initials: I
authors.lastname: Wickramasekera
authors.forename: Steven M.
authors.initials: SM
authors.lastname: Baskin
authors.forename: Donald B.
authors.initials: DB
authors.lastname: Penzien
authors.forename: Gretchen
authors.initials: G
authors.lastname: Tietjen