SCOTTSDALE, ARIZ. – Medications have their rightful place in headache treatment, but a strong dose of some key coping and behavioral tools can go a long way toward helping patients manage their own headaches, Alvin E. Lake III, Ph.D., said at a symposium sponsored by the American Headache Society.
The placebo effect has long shown how powerful an influence perception can be in how patients experience pain, and research shows that effect to be particularly important in headaches, he said.
In fact, nearly every published headache study comparing drugs alone with a combination of drugs and behavior therapy has shown the combined treatment to be superior, said Dr. Lake, who is director of the division of behavioral medicine at the Michigan Head-Pain & Neurological Institute in Ann Arbor, Mich.
“We can emphasize the power of drugs in our interventions, or we can emphasize the coping skills, but it doesn't have to be either/or because there are ways to think of them together,” he said.
An important starting point in teaching patients self-efficacy in headache control is to convey the sense of confidence that they can indeed prevent and control headaches, and that they can remain calm and continue to function, Dr. Lake said.
Establishing those core beliefs gives patients a critical sense of control over pain; research has shown that people's beliefs that they can accomplish something are better predictors of their actually accomplishing it than are most other factors, including past performance, he said.
Clinicians can help build up those beliefs by presenting examples of people who had similar obstacles and overcame them. “What often inspires us the most and changes our behavior is seeing someone else who overcame it,” Dr. Lake said.
In addition to noting others' experiences, clinicians can suggest that patients look to their own experiences and think of an obstacle that they overcame. “Urge patients to consider how they overcame it and think about how they could use those same skills in managing or preventing their pain,” Dr. Lake said.
Patients should, however, also work to try to raise their level of pain tolerance. This effort is especially important among patients who are trying to decrease excessive use of analgesics and who will likely have to deal with some pain in the process. “These patients need to learn to tolerate some level of pain without reaching for a painkiller,” Dr. Lake said.
Deep breathing skills and other relaxation methods can be useful tools in pain tolerance, and optimal health behavior, including nutrition and sleep regulation, should be encouraged to further control headaches.
Finally, Dr. Lake emphasized that a clinician's enthusiastic reinforcement of adaptive behavior can make a bigger difference to patients than some doctors may realize. “Reinforcement is a huge factor in our relationships with patients,” he said. “I think we sometimes don't recognize how important our relationship is with patients.”