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Psychological Contributors
to Headaches

Why you need to be aware of them

Like many chronic headache sufferers, you might be surprised to learn that emotional and psychological factors may play a role in your headache pain. Many people know about other contributing factors such as heredity, food triggers, lack of sleep, poor posture, etc., but are not aware of any psychological connection. If you are among them, you may be missing an opportunity to help improve your situation.

Headache specialists report that many of their patients resist any discussion of emotional or psychological contributors to their recurrent headaches. So, it's common to feel uncomfortable about this subject. Some people fear that pursuing this avenue could uncover evidence of "mental illness". Others feel that the existence of these factors would make their pain less real because it would then be "all in their heads". In just about all cases, neither of these 2 things is true!

This article will explain the role that emotional and psychological factors may play in headaches, and why it could be to your advantage to examine these as part of a comprehensive headache management plan.

Headache is definitely a biological disorder. However, since the body and the mind are interconnected, your emotional and psychological states can have an effect on your overall health, including your headaches. Here's why:

• When your emotional and psychological systems are in good working order, they help to create a positive environment that contributes to the health of your body.

• When these systems aren't working so well...for example, if you feel anxious, depressed or angry on a frequent basis—and especially if you find it difficult to shake these feelings—a negative environment can be created in your body that may contribute to a specific headache episode or create a fertile breeding ground for headaches to occur.

The relationship between anxiety, depression and headache is not fully understood. However, it is known that the brain chemical serotonin plays a role in all of them. Some headache specialists have theorized that these disorders may share a common mechanism in the brain.

Research has shown that some chronic headache sufferers also suffer from depression and/or anxiety. It is important to note that these sufferers' psychological conditions may not be caused by their headaches. Rather, tendencies towards depression or anxiety may be inherent in their personalities or ways of thinking. Or, they may be the result of an intense and prolonged level of stress which may lead to psychological conditions such as anxiety or depression. Regardless of the cause, having frequent headaches and feeling a lack of control over them may cause an existing condition of depression or anxiety to worsen. This situation can easily snowball, creating a vicious cycle of headache and emotional distress.

Unfortunately, emotional and psychological factors are often not considered in the treatment of headache. Doctors (especially those who are not headache specialists) tend to emphasize medical treatment—and rightly so. This is the traditional "first line of defense" and is effective for most headache patients. So is appropriate to start—and, for most, to stop—there. Also, some doctors today are cautious not to focus on psychological factors during the earlier stages of headache treatment—possibly overcompensating for the days when many doctors treated patients as if the pain was "all in their heads".

Doctors who do bring up psychological contributors as a possibility often find that their patients want to avoid psychological treatment, fearing a "mentally ill" diagnosis or having a concern that the presence of these factors would mean that their headaches are not a serious medical problem. This is very unfortunate because nothing could be farther from the truth!

If you have symptoms of anxiety, depression or chronic stress—or if your current headache treatment plan has not provided the relief you're looking for—short-term psychological counseling may be appropriate in addition to what you're doing now. These symptoms include:

• Sadness
• Feeling inadequate
• Feeling stuck or trapped
• Hopelessness
• Anger
• Resentment
• Feeling overwhelmed or out of control
• Feeling panicked or fearful

Other symptoms that may be a cause for concern are:

• Loss of energy
• Difficulty concentrating
• Difficulty sleeping
• Decreased interest in things you once found pleasurable

If you choose to pursue this avenue of treatment, be sure to choose a mental health professional who is knowledgeable about headaches. Ideally this would be someone who is a member of a headache clinic team along with the doctors who are currently treating you. In this situation you will benefit from a "multi-modal" approach, in which professionals from different medical disciplines address your problem together.

The most important thing to remember is that the psychological symptoms that may be associated with chronic headaches are not abnormal. Admitting that these may be factors in your headache pain should not be viewed as a sign of personal weakness. In many cases, addressing them in an open-minded and honest fashion holds the key to relief.

For more information, read Taking Control of Your Headaches by Paul Duckro, Ph.D., William Richardson, M.D., and Janet Marshall, R.N. (The Guilford Press, $14.95). This user-friendly guide emphasizes the importance of a multi-modal approach to headache treatment, including traditional medical treatment, physical therapy and psychological management. It will set most readers at ease regarding emotional and psychological contributors to headaches.

Many thanks to Dr. Steven Baskin, PhD, Director of the New England Institute for Behavioral Medicine in Stamford, CT, who generously contributed to the development of this article.

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