Commentary: salient aspects of research in pediatric headache and future directions.

Abstract

chronic headaches, although not clinically depressed or anxious, may be at risk for developing emotional problems as they reported subclinical symptoms. These subclinical symptoms may be a consequence of living with the pain (Andrasik et al., 1988; Hoelscher & Lichstein, 1984). Based on the research designs employed thus far, a causal relationship cannot be inferred, even if personality traits or emotional difficulties are found to differentiate children who are headache sufferers from children without headache. Only with prospective studies can we begin to determine the relative impact of psychosocial factors in the development of pediatric headache. Positive reinforcement for reporting pain has been suggested as a factor in maintaining pain behavior but has not been systematically studied with children who have headaches. Conditioning of pain behavior could foster the development of a maladaptive coping pattern of responding to stress with reports of headaches. The effects of behavioral conditioning have been studied in adults with chronic pain and have been found to be an important factor in understanding and treating chronic headache. Ramsden, Friedman, and Williamson (1983) report the only study that has specifically evaluated contingency management procedures for pediatric headache. Other recent studies evaluating biofeedback and relaxation training have included contingency management procedures for parents and teachers to implement. These studies have reported positive results, but the increased effectiveness of including contingency management has not been determined. Journal of Pediatric Psychology, Vol. 24, No. 2, 1999, pp. 113–114