title: Cognitive-behavioral group treatment for disabling headache.
abstract: OBJECTIVE
  Severe, disabling headache is costly to individual sufferers, through pain and reduced functioning, and to society, through decreased work productivity and increased health care use. First-line prophylactic agents combined with triptans do not adequately benefit many disabled headache sufferers. We sought to investigate whether a cognitive-behavioral treatment targeting the psychological and behavioral factors that contribute to disabling headache may provide additional benefit and whether using a group format may provide a more intensive clinic-based treatment without increasing the cost of service delivery.
  
  
  METHODS
  We developed and piloted a cognitive-behavioral group treatment for chronic, disabling headache. We evaluated its effectiveness in decreasing headache, reducing symptomatic medication use, and improving quality of life.
  
  
  METHODS
  A behavioral headache management program of an academic medical center.
  
  
  METHODS
  Sixty-two individuals suffering from primary headache disorder with moderate to severe headache-related disability who completed treatment.
  
  
  METHODS
  Individuals completed a pretreatment evaluation, the 10-session cognitive-behavioral group treatment, and a 1-month-posttreatment evaluation.
  
  
  METHODS
  The impacts of treatment on headache (frequency, intensity, and duration), medication use, and quality of life were assessed.
  
  
  RESULTS
  Separate multivariate analyses of variance revealed significant improvements in headache, symptomatic medication use, and quality of life. Overall, 50% of participants experienced at least a 50% reduction in headache frequency from pre- to posttreatment.
  
  
  CONCLUSIONS
  The findings provide preliminary evidence that delivering a clinic-based, group-format cognitive-behavioral treatment to moderately to severely disabled headache sufferers can decrease headache activity, reduce symptomatic medication use, and improve quality of life.
authors.affiliation: Centers for Behavioral and Preventive Medicine, Brown Medical School and The Miriam Hospital, Lifespan Academic Medical Center, Providence, Rhode Island 02903, USA. Justin_Nash@Brown.edu
authors.forename: Justin M
authors.initials: JM
authors.lastname: Nash
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Park
authors.forename: Barbara B
authors.initials: BB
authors.lastname: Walker
authors.forename: Norman
authors.initials: N
authors.lastname: Gordon
authors.forename: Robert A
authors.initials: RA
authors.lastname: Nicholson
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006261:Headache / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D059408:Pain Management; D010865:Pilot Projects; D011788:Quality of Life