Cognitive behavioural headache therapy
Headache service within an integrated health organisation
Modern healthcare is embedded in a network of local health services that collaborate with each other. Clinics for people with posttraumatic headaches can probably be found in Accident and Emergency departments, or in brain trauma rehabilitation or pain management centres.
Hence, it seems important for the clinicians working in interlinked departments to share an agreed treatment philosophy. This is often grounded in the term “rehabilitation.” The World Health Organisation (WHO) model for rehabilitation also applies the classification of functioning, disability and health to headache disorders. This means that headache conditions are given the same attention by health and rehabilitation services as any other condition (Figure 2.3). Most importantly, the WHO’s description of rehabilitation needs has eliminated the distinction between conditions with an established pathology and those caused by environmental factors, cognitive/ emotional disturbances or stress. It is acknowledged that people’s presenting problems are associated with multiple factors, of which physical pathology might be just one.
The cognitive behavioural formulation for posttraumatic headaches appears to fit perfectly into this WHO rehabilitation model. Starting with the description of the health problem, this approach moves through a process that focuses, first, on the physical problems, then on the implementation of therapeutic activities and, finally, on participation in meaningful roles. The components of a health condition such as headaches and mild brain trauma, as well as past and present personal and environmental factors, determine the type of rehabilitation activity and the direction of adaptive lifestyle changes. Such a framework is helpful in easing the communication of patients’ progress between involved doctors, headache therapists, linked support services and, of course, the patients themselves.
An integrated and networked healthcare system can mean that patients with posttraumatic headaches may work with a range of specialists during their journey from injury to well-being. Programmes for people with posttraumatic headaches may be an integral part of a brain trauma or pain management service. The therapy components - assessment, formulation and intervention - may be offered in one-off headache clinics and/or headache therapy alongside other rehabilitation programmes. They may involve individual and group work and could include the patient’s family.
Figure 2.3 World Health Organisation model applied to headache therapy.
