Debra F. Neff

Social validation of the headache diary

Ratings obtained from the significant others of treated headache patients were compared to daily diary ratings made by the patients themselves in order to socially validate the headache diary. The correlation between these two measures was significant (r=0.44). Global ratings made by the patients correlated significantly with the diary reports (r=0.36). These results indicate that the improvement detected by the headache diary, the most common form of self-report assessment in headache research, is observed to a significant degree by others in the patients environment.

Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or, the machines may be necessary some time of the time

Abstract Two studies are reported in which patients with chronic headache, who did not improve significantly as a result of a 10-session, 8-week relaxation training program, were subsequently treated with biofeedback. For the tension headache sufferers, 36% of the relaxation non-responders showed significant improvement with frontal EMG biofeedback training. For those with vascular headaches, 44% of the relaxation non-responders showed significant improvement with thermal biofeedback. Vascular headache patients with combined migraine and tension symptoms did better than those with only migraine. Psychological test scores significantly differentiated successful vs non-successful biofeedback responders.

Relaxation training for tension headache: Comparative efficacy and cost-effectiveness of a minimal therapist contact versus a therapist-delivered procedure

This study compared the clinical utility and cost-effectiveness of a standard, therapist-delivered relaxation treatment of tension headache to a comparable procedure administered with minimal therapist contact and based chiefly at home. Both procedures were highly effective and nearly equivalent for reducing headache complaints, as assessed by measures of headache index, intensity, frequency, and of medication consumption. The minimal contact, home-based treatment was shown to be more cost-effective when relating total amount of therapist contact to headache improvement. These findings suggest that the home-based relaxation treatment may constitute a viable, low-cost alternative to the more typical, but expensive, clinic-based procedures in the treatment of tension headache.

Behavioral treatment of 250 chronic headache patients: A clinical replication series

The results from the behavioral treatment (relaxation and/or biofeedback) of 250 chronic headache patients are presented along with information on individual predictors of treatment outcome. Relaxation alone leads to improvement in 41% of tension headache patients while a combination of relaxation and thermal biofeedback leads to improvement in 52% of migraine and combined headache patients. Predictor variables which frequently appear include age, Trait Anxiety, and MMPI scales 1 and 3.

Four process studies in the behavioral treatment of chronic headache.

Abstract Four studies of ‘process’ variables in the behavioral treatment of chronic headache are examined. No relation between headache activity-level reduction and therapist variables such as level of experience (study 1) or warmth, competence or helpfulness as perceived by the patient (Study 2) was found from treatments using relaxation training and/or biofeedback. A significant relation was found, however, between regularity of relaxation practice at home (Study 4) and headache-activity reduction and between regularity of showing some degree of hand warming in thermal biofeedback treatment for vascular headache and headache activity-level reduction (Study 3). Finally, no relation was found between changes in EMG and headache activity-level for tension-headache sufferers treated with frontal EMG biofeedback.

The relationship between capacity for absorption and chronic headache patients' response to relaxation and biofeedback treatment

A sample of 49 chronic headache patients (35 vascular and 14 tension) was separated according to capacity for absorption (as measured by Tellegen & Atkinsons 1974 scale) into groups high in absorption and groups low in absorption, with patients in the middle range being excluded. Absorption capacity was found to affect response to treatment in complex ways. Vascular headache patients high in absorption were significantly improved following relaxation training, but not after biofeedback training. Vascular headache patients low in absorption were significantly improved after biofeedback training. Tension headache patients low in absorption did not respond significantly to either form of treatment, while those high in absorption responded significantly to biofeedback training. Reasons for these differences in response to treatment were discussed.

A Bio‐psycho‐social Investigation of Headache Activity in a Chronic Headache Population *

SYNOPSIS

Psychophysiological responses as predictors of response to behavioral treatment of chronic headache

A battery of psychophysiological responses including forehead EMG, skin temperature, skin resistance level and heart rate, measured under several conditions including baseline, self-relaxation, and self-control, and stresses such as mental arithmetic and cold pressor, was collected on patients with three types of headache prior to any treatment. With this battery we can predict from 31.5 to 70.2% of the variance in posttreatment headache activity level scores for patients treated with relaxation and biofeedback. Moreover, we can correctly classify as successful or unsuccessful, after either relaxation training or biofeedback training, from 72.7 to 89.7% of subsamples based on headache type and treatment regimen.