Psychologic aspects of chronic headache.

Chronic recurrent headache affects 45 million Americans. Despite recent advances in medical modes of therapy for headache, the underlying pathophysiology for the condition is not yet fully understood. Like other conditions for which we have no objective markers for disease, nor a clear understanding of pathophysiology, psychologic causes are suspected. Although mounting evidence suggests a biochemical basis for headache, many clinicians still believe that psychologic influences may contribute to maintaining headache chronicity. Nonpharmacologic and psychologic treatment modalities such as biofeedback and cognitive/behavioral therapy may be successfully used as part of a comprehensive treatment program to give patients a greater sense of control, reverse anticipatory anxiety, and improve functioning and quality of life.