Headache therapy session 3: coping with headaches

Useful material

ABC of headaches worksheet ABC of overcoming headaches worksheet Activity planner & well-being schedule Headaches after mild brain trauma Figure 2.5 Headache diary

My headache formulation worksheet My well-being actions worksheets 1 & 2

Patient’s assessment information: interview and questionnaire outcomes.

Objectives

• • Cognitive behavioural headache formulation
• • ABC of headaches
• • ABC of headache management: A = adjustment anticipation, adversity and adjustment
• • Emotional resilience
• • Headache coping strategies

Headache monitoring

Notes for therapist'. Discuss observations recorded in the headache diary. The diary analysis at this stage in therapy should be done in comparison with responses in the initial interview and questionnaires.

• - What are the headaches like exactly?
• - What are the consequences of the headache?

How were the headache episodes dealt with immediately afterwards? Has anything changed since the initial assessments?

If so, what has changed and what are the consequences?

If nothing has changed (i.e., neither headache experience nor headache- related behaviours), what are the expectations (e.g., hope for natural remission) and what is missing?

Headache coping strategies: use the activity planner & well-being schedule and my well-being actions worksheets

Notes for therapist'. Review relaxation routines. The patient has been in the programme for some weeks by now and should have a good foundation regarding relaxation practice.

Has the relaxation practice been scheduled during optimal times when the patient has felt all right and had “space”? It is important to explore obstacles to relaxation practice and, if required, to find ways to adjust relaxation strategies to the patient’s abilities. The activity planner & well-being schedule might help with that.

Reflect on spontaneously applied positive strategies:

“You have learnt a lot about your headaches in relation to stress and your body’s attempts to find a balance. Your participation in the sessions means that you are very motivated to help yourself and this indicates enormous progress. You have begun to take your well-being into your own hands and have already made considerable adjustments. Maybe now you could share those activities that have helped you reduce your headache perception and perhaps dampen or close your Pain Gate (or increase the headache threshold). What additional ideas or thoughts have you had during the previous week on how to optimise your sense of purpose and on activities to help you fulfil it? How can they fit into your activity planner & well-being schedule for next week?”

Positive strategies and well-being actions are those which:

Divert attention from pain perception

Prevent pain (e.g., change postural habits, limit exposure to triggers - long car journeys)

Prevent consequences of pain (e.g., pacing and graded activity preventing energy “bust,” adaptation of commitments)

Optimise alternative and purposeful activities (e.g., alternating outdoor activity with computer work).

Main therapy section