Headache
Edwin F. Kremer
James Hudson
Thomas Schreiffer
Headache Rehabilitation Program
Mary Free Bed Hospital and Rehabilitation Center
Headaches comprise the second most prevalent chronic, nonmalignant pain problem in the general population ( Sternbach, 1986). The majority of headache patients perform some type of self-care that may include avoidance of stress, missed time from work, curtailment of activities of daily living, or use of nonprescription medications. As Rasmussen and Olesen ( 1996) have noted, there are now several studies documenting that only a minority of headache sufferers ever seek medical treatment. Even so, headache complaint still comprises over 18 million office visits per year for diagnosis and treatment ( Stewart & Lipton, 1993).
Migraines, tension-type, and mixed headache comprise the vast majority of headache sufferers ( Rasmussen & Olesen, 1992). This chapter focuses on these three headache patient populations as they are the most likely to comprise clinical case load. The less common headaches, such as cluster headache, temporal arteritis, and so on, are addressed in several comprehensive headache texts (e.g., Dalessio & Silberstein, 1993; Diamond & Dalessio, 1992; Olesen, Tfelt-Hansen, & Welch, 1993).
The focus of the present chapter is on the multidisciplinary behavioral care of the headache patient. Despite a rich literature attesting to the efficacy of pharmacologic ( Holroyd, Penzien, & Cordingley, 1991) as well as behavioral ( Blanchard, 1992) treatment of headache, many patients continue to suffer with their head pain. This would suggest that headache is multidetermined. Successful headache resolution then would seem to require comprehensive treatment. Moreover, as at least some headache
-283-
