Behavioral Assessment Considerations in the Management of Headache

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Abstract
SYNOPSISEffective behavioral and psychophysiological treatment requires careful assessment of three components of the headache experience: (1) observable behavior, including activity, verbal complaints, moaning and grimmacing, and medication use, (2) cognitions, including self–statements and images, and (3) physiological functioning, including symptoms associated with various levels of skeletal, autonomic, end cortical arousal. In addition, behavioral assessment includes functional analysis of the antecedents and consequents of headache episodes. Antecedents include factors external to the person, from social situations to meteorological changes, as well as internal factors including behavior patterns, thoughts, and physiological arousal. Consequents – events following the occurrence of headache – include the response of other people in the patient's environment, patterns of avoiding activities because of headache, as well as the person's own subsequent behavior, thoughts, and emotional reactions.The importance of these assessment considerations in the design of appropriate treatments is illustrated with examples from patient records. These cases suggest that effective behavioral and psychophysiological intervention may depend more on the profile revealed by this type of assessment than on the diagnosis of headache type.

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