Overview
Psychological factors and their role in headache have been known for centuries and possibly millennia. In the past, it was believed that headache was caused by psychological factors; however, it is now recognized that headache is a complex biomedical disorder in which psychological factors can play a contributory, maintaining, and/or reactive role. The authors describe the interaction of psychophysiological factors with headache syndromes, the evidence for genetic and environmental factors, and novel forms of nonpharmacologic therapies for the patient with headache and psychological accompaniments. This update highlights research on psychological factors in headache-related disability and advances in cognitive behavioral treatments for headache.
Key points
Although headache is almost always a biochemical disorder, psychological factors often play a contributory role in headache onset and/or a reactive role in headache maintenance.
There is a high level of comorbidity between headache and psychiatric disorders such as depression and anxiety.
It is hypothesized that psychiatric comorbidity is a risk factor for medication overuse, causing worsening headache frequency or chronic headaches.
Because headache has a major impact on quality of life, psychological interventions such as psychotherapy and biofeedback are not only useful adjuncts to medication therapy, but also permit patients to be actively involved in managing their lifestyles.