Recurrent pediatric headaches: Behavioral concepts and interventions.

Abstract

Recurrent pediatric headaches are increasingly understood to be a function of both respondent and operant processes. In particular, the environment is thought to elicit internal autonomic instability and to evoke external maladaptive pain behavior. While medical interventions often provide an appropriate first line treatment, behavioral interventions can provide an important adjunct to medical intervention and in some cases provide valuable alternative sources of relief. This article reviews the prevalence, types, and functional impairments associated with recurrent pediatric headaches and the behavioral concepts that help explain their etiology. The article also reviews the substantial empirical research that supports the efficacy of behavioral interventions. These include teaching children to control autonomic reactivity through relaxation or biofeedback and then arranging for an environment that reinforces use of these tools. The article concludes with a discussion of future directions for research in biofeedback, including the application of behavioral concepts and interventions to other chronic health related problems in children.