Cognitive-behavioral group treatment for disabling headache

Pain Med. 2004 Jun;5(2):178-86. doi: 10.1111/j.1526-4637.2004.04031.x.


Objectives: 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.

Design: 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.

Setting: A behavioral headache management program of an academic medical center.

Patients: Sixty-two individuals suffering from primary headache disorder with moderate to severe headache-related disability who completed treatment.

Interventions: Individuals completed a pretreatment evaluation, the 10-session cognitive-behavioral group treatment, and a 1-month-posttreatment evaluation.

Outcome measures: 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.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Cognitive Behavioral Therapy / methods*
  • Female
  • Headache / psychology*
  • Headache / therapy*
  • Humans
  • Male
  • Middle Aged
  • Pain / psychology*
  • Pain Management*
  • Pilot Projects
  • Quality of Life