title: The approach to the difficult patient.
abstract: Specific patient and physician characteristics may contribute to a perception that a particular headache patient is "difficult." Headache patients with psychiatric pathology, multiple unexplained symptoms, substance abuse problems, or refractory headaches are commonly perceived as challenging to manage. Physicians who are younger, under more stress, and who do not use collaborative treatment models are more likely to find patients difficult. General principles that may be helpful in coping with headache patients perceived as difficult include: (1) evaluation for possible psychiatric or substance abuse problems with institution of specific treatment if found; (2) a shift in treatment philosophy away from a goal of cure toward a goal of management; (3) the use of written agreements that outline conditions of treatment, including medication amounts; and (4) an integrated, multimodality treatment approach including behavioral and non-pharmacological treatment.
authors.affiliation: Division of Headache and Pain, Department of Neurology, Brigham and Women’s/Faulkner Hospitals, Harvard Medical School, Boston, MA 02130, USA. eloder@partners.org
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Loder
mesh_terms: D000223:Adaptation, Psychological; D006261:Headache / Q000188:drug therapy; D006801:Humans; D019966:Substance-Related Disorders / Q000628:therapy