PSYCHOLOGICAL TREATMENT OF HEADACHE

这项建议将收集与机制有关的数据， 广泛使用的头痛（HA）的非药物治疗具有其益处。 虽然这项研究计划的长期目标是比较三个 非药物治疗（热疗法） 生物反馈[TBF]和渐进式肌肉放松[PMR]导致 为减轻慢性HA，本建议旨在收集 初步数据，以协助设计后期，大规模，更 权威研究。 这三个模型是较老的心理生理模型， 该模型假定治疗会导致生理变化， 转向导致HA缓解。 一个新的认知归因模型假设， 治疗会导致认知或归因的变化， 重新解释压力，头痛引起的事件，这反过来， 导致HA缓解。 第三种解释模型认为， 心理生理效应和认知- 归因效应导致HA缓解。 在本提案的研究1中，四种不同的生物反馈条件将 在血管HA治疗中比较：（1）TBF用于暖手， 最广泛使用的血管HA非药物治疗;（2）TBF用于 手冷却，一些研究表明，这是同样有效的（1）; (3)TBF用于手部温度稳定，有些人声称这是核心 TBF的治疗效果;和（4）EEG α生物反馈α 抑制，以控制任何血管效应。 我们亦会研究 单纯性偏头痛HA患者和混合性偏头痛HA患者， 张力HA以相同的方式响应于处理。 在研究2中，张力HA患者将接受PMR，计算机化结束 关于放松程度的会话反馈（以操纵 成功），以便具有2X2设计的等效性，两个级别的 不同程度的生理性认知-归因变化 变化 结果和模型将与头痛结果一起进行评估 措施（头痛缓解的相对程度）和过程措施 评估心理生理变化、认知和归因 变化，生活压力，情绪和应对的变化，因为它们都与 头痛缓解。

This proposal will gather data relevant to the mechanisms by which widely used, non-drug treatments of headache (HA) have their benefits. While the long-term goal of this program of research is to compare three different models of the mechanisms by which non-drug treatments (thermal biofeedback [TBF] and progressive muscle relaxation [PMR] lead to the alleviation of chronic HA, the present proposal is designed to gather preliminary data to assist in the design of later, large scale, more definitive studies. The three models are the older psychophysiological model which posits that treatment leads to physiological change which in turn leads to HA relief. A new cognitive-attributional model posits that treatment leads to cognitive or attributional changes which lead re-interpretation of stressful, headache-causing events, which in turn leads to HA relief. A third interactional model posits that it is the interaction of the psychophysiological effects and cognitive- attributional effects which lead to HA relief. In Study 1 of this proposal, four different biofeedback conditions will be compared in the treatment of vascular HA: (1) TBF for hand warming, the most widely used non-drug treatment for vascular HA; (2) TBF for hand cooling, which some studies have shown is equally effective as (1); (3) TBF for hand temperature stabilization, which some claim is central to TBF's therapeutic effects; and (4) EEG alpha biofeedback for alpha suppression, to control for any vascular effects. We will also examine whether patients with pure migraine HA and those with mixed migraine and tension HA respond in the same way to the treatments. In Study 2 tension HA patients will receive PMR with computerized end of session feedback on degree of relaxation (to manipulate attributions of success) in order to have the equivalent of 2X2 design, two levels of cognitive-attributional change by varying degrees of physiological change. The results and models will be evaluated both with headache outcome measures (relative degree of headache relief) and with process measures evaluating psychophysiological change, cognitive and attributional change, and change in life stresses, mood and coping as they all relate to headache relief.