A component-analysis of psycho-physiological management of migraine and tension headache.

M.A.In all communities studied, most people suffer from headaches sometime in their life (Blau, 1991; Selby, 1983). A small portion of this group suffer from both migraine and tension-type headache on a regular basis. Currently the main treatment modality for headache is pharmacological in nature. This type of treatment is limited in as far as it does not address the concomitant psychological variables that often accompany chronic headaches. Furthermore, it seems that most psychophysiological therapies were developed in the USA and Canada over the last 30 years, but thus far research has not been done within the South African context. The aim of this study was to determine the effectiveness of an individualized psychophysiological treatment program for individuals suffering from migraine and tension-type headache. A change in headache activity and mood states such as anxiety and depression was envisaged. Seven subjects suffering from both migraine and tension-type headache were selected to participate in the study. The A-B-A single-subject design was employed allowing three weeks before and after the intervention for baseline recordings. The intervention consisted of seven sessions of cognitive coping training and electromyographic biofeedback. All subjects kept daily records of their headache activity over the eleven week period. They completed the Psychological Assessment of Headache Questionnaire, levels of depression and anxiety were assessed by the Beck Depression Inventory and the State-Trait Anxiety Inventory which were administered three weeks prior to and after the intervention. Results indicated that subjects who exhibited a decrease in headache frequency and intensity and an increase in the number of headache-free days per week, were those who were not habituated to analgesic medication. Subjects who reported no differences at all with regard to headache activity were those who suffered from chronic daily headache. Those subjects were older and consumed analgesic and other medications daily. These findings support those found in literature (Blanchard & Andrasik, 1988). All but one subject reported lower scores at post-assessment on indicators of depression and state-anxiety. Even though there were no significant improvements regarding headache activity, for certain subjects. The overall aim of the study, namely to evaluate the effectiveness of individualized treatment strategies, were addressed and contribute to future intervention studies