title: Challenges of nonpharmacologic interventions in chronic tension-type headache.
abstract: Interest in nonpharmacologic interventions for chronic tension-type headache has increased in recent years, with many professional organizations recommending behavioral treatments such as relaxation training, biofeedback, and cognitive-behavioral therapy alongside pharmacologic treatments. Although the efficacy of behavioral interventions is well-documented, several potential barriers in dissemination and implementation exist that have precluded more widespread adoption of behavioral treatments. This article briefly reviews the core components and efficacy of behavioral treatments for tension-type headache and outlines challenges to their broader clinical use as they occur at the levels of empirical research, treatment availability and delivery, and common clinical problems. Strategies for addressing these challenges are suggested, and directions for needed research are noted.
authors.affiliation: Head Pain Center, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA. tsmitherman@residents.umsmed.edu
authors.forename: Todd A
authors.initials: TA
authors.lastname: Smitherman
authors.forename: Donald B
authors.initials: DB
authors.lastname: Penzien
authors.forename: Jeanetta C
authors.initials: JC
authors.lastname: Rains
mesh_terms: D001521:Behavior Therapy; D001676:Biofeedback, Psychology; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003695:Delivery of Health Care; D051271:Headache Disorders, Secondary; D006801:Humans; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D012064:Relaxation Therapy; D012107:Research Design; D012893:Sleep Wake Disorders / Q000150:complications / Q000523:psychology; D018781:Tension-Type Headache / Q000191:economics / Q000523:psychology / Q000628:therapy*; D016312:Treatment Refusal