Headache Sufferers Research Articles

Is sexual function impaired in patients with primary headaches? A systematic review of observational studies.

Primary headaches, particularly migraine and tension-type headaches, as chronic and painful conditions, have a significant impact on individuals' health and overall quality of life, including aspects such as sexual health parameters. The aim of this study was to review observational studies and to summarize the presence of sexual dysfunction in patients with primary headache and to discern whether it is more common in patients with primary headache than in healthy control subjects. Observational studies published between January 1, 2000, and May 21, 2023 were searched in Medline (PubMed), Web of Science, Scopus, and EBSCO. This review included 23 observational studies that evaluated sexual dysfunction with or without comparison with healthy control subjects. As a result, the mean Female Sexual Function Index score, a score of <26.55 indicating sexual dysfunction, ranged from 19.25 ± 8.18 to 27.5 ± 7.5 in patients with primary headache. The prevalence of sexual dysfunction and erectile dysfunction was found to be between 10.7% and 93.75% in female patients and between 54.83% and 80% in male patients. Both migraineurs and tension-type headache sufferers had statistically significantly lower sexual function scores in females and lower erectile function scores in males compared with healthy control subjects. Sexual function is significantly affected in patients with primary headache, which is a chronic painful disorder. Therefore, it is very important to ask these patients about their sexual health and, if necessary, to seek support from a sexual health professional. Additionally, future studies may prioritize tension-type headaches and male patients due to the limited amount of research available on these subjects.

Transcranial direct current stimulation for chronic headaches, a randomized, controlled trial.

Chronic headaches are a frequent cause of pain and disability. The purpose of this randomized trial was to examine whether transcranial direct current stimulation (tDCS) applied to the primary motor cortex, reduces pain and increases daily function in individuals suffering from primary chronic headache. A prospective, randomized, controlled trial, where participants and assessors were blinded, investigated the effect of active tDCS vs. sham tDCS in chronic headache sufferers. Forty subjects between 18 and 70 years of age, with a diagnosis of primary chronic headache were randomized to either active tDCS or sham tDCS treatment groups. All patients received eight treatments over four consecutive weeks. Anodal stimulation (2 mA) directed at the primary motor cortex (M1), was applied for 30 min in the active tDCS group. Participants in the sham tDCS group received 30 s of M1 stimulation at the start and end of the 30-minute procedure; for the remaining 29 min, they did not receive any stimulation. Outcome measures based on data collected at baseline, after eight treatments and three months later included changes in daily function, pain levels, and medication. Significant improvements in both daily function and pain levels were observed in participants treated with active tDCS, compared to sham tDCS. Effects lasted up to 12 weeks post-treatment. Medication use remained unchanged in both groups throughout the trial with no serious adverse effects reported. These results suggest that tDCS has the potential to improve daily function and reduce pain in patients suffering from chronic headaches. Larger randomized, controlled trials are needed to confirm these findings. The study was approved by the local ethics committee (2018/2514) and by the Norwegian Centre for Research Data (54483).

Primary Headaches among Students in a South African University

Headaches are recognised as a common health-related complaint, impacting student attendance and overall productivity. This study determined the prevalence of headaches within a selected group of students and its effects on their health. A questionnaire was administered to undergraduate allied health science students in three selected departments at a university in South Africa. A total of 420 students were invited to participate in the study, of which 314 participated (75% response rate) – 311 students completed the questionnaire. Of these, 27.0% (n=84) did not experience headaches over the previous three months; the remaining 73.0% (n=227) were classified as having had migraine-type headaches (31.2%; n=97), tension-type headache (30.2%; n=94) or cluster-type headache (1.3%; n=04). Students suffering with migraine-type headaches indicated a decrease in capacity and missed classes more frequently compared to students who experienced tension-type headaches and cluster-type headaches respectively. Some of the respondents with migraine-type headaches (53.4%; n=31) did not continue with classes in order to rest. Migraine-type headache sufferers were more likely to take medication than those with other types of headaches (p=0.014). The findings of the study highlight the influence of headaches on students. Health knowledge and access to treatment is highlighted as a simple contributor to reducing headache prevalence and attaining overall health and well-being.

A study of cardiovascular reflex tests in adults with chronic migraine and chronic tension-type headache

Background: Autonomic function tests can be used by patients with chronic migraine and chronic tension-type headaches (TTH) as a non-invasive, sensitive, and reliable marker for evaluating heart function. Studies have demonstrated sympathetic and parasympathetic dysfunction. Patients with migraines experience sympathetic and parasympathetic nervous system hyperfunction, while tension headache sufferers experience the opposite. Aims and Objectives: Parasympathetic reactivity tests will be used in the current study to evaluate the cardiac autonomic functioning in patients with chronic migraine and chronic TTH in the adult age group. Materials and Methods: Two groups of headache patients were enrolled: Those with chronic migraine (n=25) and those with chronic TTH (n=25). To conduct statistical analyses, SPSS version 21 was used. For parameters with normal and abnormal distributions, the unpaired t-test and Mann–Whitney U-test, respectively, were employed. Results: Out of 25 subjects, parasympathetic reactivity tests such as Valsalva ratio (1.38±0.10 vs. 1.49±0.19, P=0.022*) and expiratory-inspiratory ratio (1.18±0.03 vs. 1.25±0.77, P=0.000*) in chronic migraine were significantly decreased as compared to chronic TTH. Lying to standing 30:15 ratio (1.15±0.08 vs. 1.19±0.10, P=0.090) and delta heart rate (14.56±1.39 vs. 14.96±1.43, P=0.320) was decreased in chronic migraine as compared to chronic TTH but was not significant. Conclusions: In contrast to the chronic TTH group, the chronic migraine group’s total parasympathetic tone was reduced. We therefore draw the conclusion from the findings that regular monitoring of the parasympathetic reactivity can be very helpful in predicting cardiovascular risk for these patients in addition to advising the treatment practices for chronic migraine and chronic TTH, which include regular exercise and medication.

Comparison of C-reactive protein, D-dimer, vitamin D and magnesium serum levels between migraineurs and tension-type headache sufferers

Headaches, especially migraines and tension-type headaches (TTH), are among the most prevalent problems encountered in neurology and medicine. Ongoing debate surrounds the pathophysiological mechanisms behind this condition. One of the potential ideas involves inflammation and diet. The purpose of the study was to compare the serum levels of C-reactive protein (CRP), D-dimer, vitamin D and magnesium in 23 migraineurs and 23 TTH-diagnosed sufferers. The CRP level (4.8±3.7 mg/L) was found to be significantly different between migraineurs and TTH sufferers, with a significant difference (p=0.03) between the two groups of headache sufferers. Vitamin D serum levels (19.5±7.9 ng/L) and TTH serum levels (26.7±8.4) were observed to differ significantly. Magnesium serum levels (p=0.692) did not differ significantly between the two headache patient groups.

Prevalence, natural history and dynamic nature of chronic headache and medication overuse headache in Italy: The SPARTACUS study.

Chronic headaches and medication overuse headache are common and burdening conditions. No studies have evaluated the prevalence of chronic headache and medication overuse headache in an unselected Italian population. We performed a three-year cross-sectional and longitudinal population-based study to investigate prevalence, natural history, and prognostic factors of chronic headache. We delivered a self-administered questionnaire to 25,163 subjects. Chronic headache patients were interviewed by General Practitioners. After three years, medication overuse headache patients were invited to undergo a neurological evaluation at our Center. 16,577 individuals completed the questionnaire; 6878 (41,5%) were episodic headache sufferers and 636 (3.8%) were chronic headache subjects. 239 (1.4%) patients were acute medication over-users. All medication overuse headache patients had migraine or headache with migrainous features. At the three-year follow-up of 98 patients, we observed conversion to episodic headaches in 53 (54.1%) patients. 27 (50.9%) patients remitted spontaneously. We present the first prevalence data on chronic headache and medication overuse headache in an unselected Italian population and a high rate of spontaneous remission. These data support the interpretation of medication overuse headache as a specific migraine-related disorder that may reflect chronic migraine's dynamic nature, the need for more specific medication overuse headache diagnostic criteria, and highlight the priority of targeted public health policies.

Psychobiological Influences for Stress Load in Young Girls with Chronic Headache

Chronic headache in adolescents is frequent, and stress may play an important role. The empirical literature suggests that stress load of headache sufferers is increased but stress coping is limited. The present study investigated in a controlled design differences between girls with chronic headache and controls in stress load and stress coping. Additionally psychopathological characteristics such as anxiety and depression were measured and a biological indicator for chronic stress (the cortisol awakening response) was obtained 148 girls were investigated. Stress load and stress coping was measured by validated German questionnaires. Saliva samples were collected at home after awakening. Girls with headache had a higher stress load and higher stress vulnerability, but significant deficits in stress coping. The cortisol awakening response was increased specifically for girls with headache. Physiological as well as psychological stress load could be significantly predicted by multiple linear regressions. Significant predictors were inadequate stress coping, anxiety and depression, but not hyperactivity of HPA axis. The results were integrated into the available literature and further discussed within a psychobiological model of chronic headache in adolescents.

Clinical-Epidemiology of Tension-Type Headache among the Medical and Dental Undergraduates of King Khalid University, Abha, Saudi Arabia.

Introduction (background): Headache is the primary complaint among students. Headaches mostly have multifactorial causes. The degree of headache severity significantly impacts attitudes, behavior, and academic performance. Objectives: Here, we investigate the demographic epidemiology of tension-type headaches (T.T.H.), and determine the clinical presentation and triggers of the tension-type among headache sufferers. Methods (settings, design): An institutional-based cross-sectional study (descriptive) was conducted on the medical and dental undergraduates at King Khalid University, Abha, Saudi Arabia, from 1 July 2021 to 31 December 2021. Data were gathered using a pre-designed questionnaire. A consecutive sampling method was used in a COVID-19-constrained environment. After preliminary screening of the study population, 460 samples were included. An electronic questionnaire was shared with them, and they were requested to respond. Results: More than half of the participants (258, 56.1%) experienced tension-type headaches, while the remaining 202 (43.9%) never felt a headache. Tension-type headaches manifested as heaviness of the head (44, 17.0%), tightness (126, 48.8%), and dull aching pain (66, 25.7%). Conclusions: T.T.H. is a prevalent condition with a significant impingement on academic work, and psychological health. Tension-type headache sufferers are advised to keep daily diaries to determine triggers, and plan for prevention and treatment progression.

Prevalence, frequency, and disability of migraine headaches and tension headaches among the general population in the Eastern Region of Saudi Arabia

A tension-type headache (TTH) is a recurrent headache that is mild to moderate in intensity, unlike migraine (MH), which is accompanied by crippling effects of nausea, vomiting, photophobia, or phonophobia. TTH is more frequent than migraine, but it is less likely to cause severe pain and physical dysfunction. TTHs account for more lost workdays due to their prevalence. The study aimed to evaluate the prevalence, frequency, and disability of MHs and TTHs among the general population in the Eastern Region of Saudi Arabia. A cross-sectional study was employed using a validated questionnaire. The questionnaire implemented the HARDSHIP algorithm to diagnose MH and TTH and questions to correlate their prevalence to socio-demographic data, measurement of the level of disability, headache management, and treatment effectiveness using the chi-square test. The study reviewed 877 subjects (46.6% males vs. 53.4% females). 52.9% of the participants experienced headaches during the previous three months, and 35.6% experienced headaches recently. The most common type of headache was a probable MH (32.1%), followed by a TTH (26.9%), probable TTH (19.5%), and MH (15%). It was reported that some disability was attributed to 47% of MHs and 26% of TTHs. The most commonly used headache medication was paracetamol (53.5%). This study revealed that TTH and MH are common illnesses in Saudi Arabia's Eastern Region. TTH and MH are correlated with significant individual and social burdens, particularly for MH. Headache sufferers mostly manage their headaches using conventional over-the-counter methods.

Biochemical and behavioral effects of decreasing dietary linoleic acid and increasing eicosapentaenoic acid and docosahexaenoic acid in a rat chronic monoarthrits model

Clinical studies have demonstrated that decreasing linoleic acid (LA) while increasing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in diets evokes an analgesic effect in headache sufferers. We utilized a rat chronic monoarthritis model to determine if these analgesic effects can be reproduced in rats and to and further probe potential analgesic mechanisms. We fed 8 rats a control diet (with fatty acid levels similar to standard US diets) and 8 rats a low LA diet with added EPA and DHA (H3L6 diet) and after 10 weeks, performed a unilateral intraarticular injection of Complete's Freund Adjuvant (CFA). We evaluated thermal and mechanical sensitivity as well as hind paw weight bearing prior to and at 4 and 20 days post CFA injection. At 28 days post CFA injection rats were euthanized and tissue collected. H3L6 diet fed rats had higher concentrations of EPA and DHA, as well as higher concentrations of oxidized lipids derived from these fatty acids, in hind paw and plasma, compared to control fed rats. LA and oxidized LA metabolites were lower in the plasma and hind paw of H3L6 compared to control fed rats. Diet did not affect thermal or mechanical sensitivity, nor did it affect hind paw weight bearing. In conclusion, the H3L6 diet evoked biochemical changes in rats but did not impact pain related behavioral measures in this chronic monoarthritis model.

Readability of online health information pertaining to migraine and headache in the UK.

An estimated 46% of the worldwide adult population live with an active headache disorder, and it is thought that there is a proportion of headache and migraine sufferers who do not attend for medical care, instead choosing to manage their symptoms at home. The internet continues to act as a source of online health information for self-management, however, it is important that this information can be understood by the user. Research indicates that most health information online is written at a level too difficult for much of the UK population to understand. The aim of this study was to investigate the readability of online health information pertaining to headache and migraine for a UK-based internet user accessing the top four search engines. Searches for 'headache' and 'migraine' were performed on each search engine and results from the first page were selected for analysis. Five validated readability tests were used to analyse readability; Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Index, Coleman-Liau Index and Simple Measure of Gobbledygook Index. We found that the majority of online health information about migraine and headache is too difficult for the UK adult population to read. Findings highlight work is required to ensure that information from a wider variety of sources is easier to comprehend for much of the population in order for individuals to make informed decisions about health seeking and self-management of headache and migraine. Health information providers should weave readability analysis into their content design process, incorporating shorter sentences and simpler words in their description of conditions and treatment.

A Review on Headaches Due to COVID-19 Infection.

Since December 2019, the time when the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was spotted, numerous review studies have been published on COVID-19 and its neuro invasion. A growing number of studies have reported headaches as a common neurological manifestation of COVID-19. Although several hypotheses have been proposed regarding the association between headache and the coronavirus, no solid evidence has been presented for the mechanism and features of headache in COVID-19. Headache also is a common complaint with the omicron variant of the virus. COVID-19 vaccination also is a cause of new-onset headaches or aggravation of the previous headache in migraine or tension headache sufferers. In this review study, the types of headaches reported in previous studies and their possible pathogenic mechanisms are outlined. To accomplish this objective, various types of headaches are classified and their patterns are discussed according to ICHD-3 diagnostic criteria, including, headaches attributed to systemic viral infection, viral meningitis or encephalitis, non-infectious inflammatory intracranial disease, hypoxia and/or hypercapnia, cranial or cervical vascular disorder, increased cerebrospinal fluid (CSF) pressure, refractive error, external-compression headache, and cough headache. Then, their pathogeneses are categorized into three main categories, direct trigeminal involvement, vascular invasion, and inflammatory mediators. Furthermore, persistent headache after recovery and the predictors of intensity is further investigated. Post-vaccination headache is also discussed in this review.

Migraine management: an update for the 2020s.

Migraine is a common malady cutting across socioeconomic and ethnic divides in Australia. It is typically diagnosed late with significant impact on quality of life. Management options have emerged over the past several years that promise simpler treatment regimens with less potential for side‐effects. The development of rationally designed migraine preventives is the most significant advance in treatment since the development of the triptans and delivers significant hope to many headache sufferers.

Stress Related Determinants of Anxiety and Depression in Young Girls with Chronic Headache

Girls with chronic headache often suffer also from marked anxiety and depression. The present study used psychological and biological characteristics related to stress load and stress coping to predict anxiety and depression. This was done by regression analysis. Anxiety could be better explained than depression. Psychological and physiological stress load played a significant role, but not activity of HPA axis, although cortisol awakening response was heightened specifically for headache sufferers.

Study to assess existing knowledge of headache disorders among registered osteopaths practising in the UK: A cross-sectional survey

BackgroundHeadache disorders are highly prevalent worldwide. Many headache sufferers search for answers outside medical and pharmaceutical models. Complementary and alternative medicine (CAM) including osteopathy are widely used by headache patients. Indeed 9% of patients consulting osteopaths do so for headaches. There is no existing assessment of headache knowledge among practising Osteopaths in the UK. MethodsThis study was a cross-sectional survey employing an anonymous online questionnaire. An original questionnaire was developed. The scope was based on established guidelines in the primary care setting. Multiple choice and closed-ended questions assessed knowledge of the diagnostic criteria, potential red flags and appropriate investigations. The answers were informed by the International Classification Headache Disorder (ICHD-3) and the British Association for the Study of Headaches (BASH) guidelines. Three case vignettes relevant to osteopathic practice were included. Participants were invited to give optional free text feedback. The questionnaire was open to be self-completed by participants for 30 days. ResultsThere were 398 responders of which 383 were included and all of whom completed the questionnaire. The study found areas where knowledge was good, areas where it was limited and areas of uncertainty. The mean knowledge score was 6.93 out of 10 (range 2.18–9.42). There was a significantly lower mean knowledge score in those who had no prior headache education of −0.716 with a difference in means (−1.075 to −0.353, 95% C.I.) compared to those with prior education. Gender and years qualified had no significant effect on mean knowledge score. Optional free text feedback was given by 81 (21.2%) of the respondents and analyzed. The main themes were acknowledgment of knowledge gaps and a desire for more headache education. ConclusionThe findings suggest there are gaps in the existing knowledge on headache among UK osteopaths and the extent of this is dependent on prior headache education. We propose that ongoing headache education among osteopaths is needed in the field.

Detoxification vs non-detoxification before starting an anti-CGRP monoclonal antibody in medication overuse headache

BackgroundMedication overuse headache significantly contributes to the chronification process and treatment refractoriness of migraine. Currently, abrupt discontinuation of the overused medication still represents the best management strategy for these patients, challenging public health system resources.MethodsIn this prospective study, chronic migraine and medication overuse headache sufferers with at least 28 days of analgesic consumption per month were included. Assessment of efficacy outcomes at three months were compared among patients who underwent in-hospital abrupt discontinuation of overused acute medication (YES-DETOX group) and patients who did not (NO-DETOX group) before starting an anti-CGRP monoclonal antibody.ResultsOf 401 patients who received either erenumab or galcanezumab, 28% (n = 111) satisfied inclusion criteria (YES-DETOX n = 28; NO-DETOX n = 83). After three months of treatment, 59% (n = 65; 47/83 YES-DETOX; 18/28 NO-DETOX) patients reverted from medication overuse headache and 51% (n = 57; 42/83 YES-DETOX; 15/28 NO-DEOTX) achieved ≥50% reduction in monthly headache days; yet no statistical differences were observed between the two groups (p = 0.4788 and p = 0.8393, respectively). Monthly consumption of pain medication was the only baseline prognostic factor in multivariate analysis in the overall cohort (p = 0.016).ConclusionOur results support the emerging evidence that anti-CGRP monoclonal antibodies may be effective in medication overuse headache patients irrespective of detoxification, yet further studies are needed to draw definitive conclusions.

HEADACHE PROFILE AND ASSOCIATED SYMPTOMS IN INTRACRANIAL TUMORS

&#x0D; Intracranial tumors are rare in headache sufferers, although headache is common in intracranial tumor patients. This limits the utility of headache symptoms to make a diagnosis, and it's crucial to know whether people with intracranial tumors have specific headache criteria. Other investigations do not support the classic criteria for headache in intracranial tumors, such as progressive, worse in the morning, and exacerbated by Valsalva maneuvers. Clinical studies found that headache as the sole symptom was rare, and only occurred in 2% of patients, hence this study also investigated the prevalence of nausea/vomiting, seizures, loss of consciousness, and motor deficits. This study uses resumes of medical records of patients diagnosed with intracranial tumors and hospitalized in the Department of Neurology, dr. Hasan Sadikin Central General Hospital West Java, Indonesia. While the sampling method in this study was total sampling, by taking all medical record resumes of patients with intracranial tumors from January to December 2018. Headache was a prevalent symptom of intracranial tumors in this study, occurring in 75,3 % of the subjects and was usually accompanied by other symptoms, especially motor deficits (64,5%), loss of consciousness (60,2%), nausea and vomiting (31) 2%), and seizures (23,7%). Patients were most likely to have bilateral headaches (62,5%), and 63,6% of patients who had unilateral headaches had a unilateral intracranial tumor on the same side of the headache. Patients who experienced progressive headaches were 93,5% of patients. While, the most common headache onset in patients with intracranial tumors before hospital admission were; 3-30 days (40,4%) and &gt; 30 days - 6 months (38,5%).&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Headache in patients with systemic lupus erythematosus: characteristics, brain MRI patterns, and impact

BackgroundThe prevalence of primary headache in patients with systemic lupus erythematosus (SLE) varies widely and whether it should be attributed to neurological involvement is controversial. We aimed to investigate the prevalence and characteristics of headache in SLE patients, describe its association with disease-related variables and brain imaging, and explore its impact on life.ResultsThe overall prevalence of headache was 54.4%, and migraine was the most common type among headache sufferers (48.4%). Headache severity (VAS) and impact (HIT-6) correlated with SLEDAI-2K (P = 0.019 and P < 0.001, respectively) as well as with each other (P = 0.006). Brain imaging abnormalities were found in 25.8%, with white-matter hyperintensities (WMH) being the most frequent pathology. Musculoskeletal manifestations, positive anti-phospholipid (aPL) antibodies, and SLEDAI score ≥ 13.5 were identified as predictors of headache.ConclusionPrimary headache, especially migraine, is a common feature of patients with SLE, and its presence is associated with negative impact on quality of life. Musculoskeletal features, aPL positivity, and overall disease activity appear to predict primary headache in SLE.

Multinational descriptive analysis of the real-world burden of headache using the Migraine Buddy application.

Background and purposeA large proportion of headache sufferers do not routinely seek medical care. App‐based technologies permit the collection of real‐world data over time and between countries that can help assess true burden of headache. This study used a mobile phone application to collect information on the real‐world burden of self‐diagnosed headache and to describe its impact on daily life in headache sufferers who do not routinely seek medical advice.MethodsThis retrospective, non‐interventional, cross‐sectional study analysed self‐reported data from users of the ‘Migraine Buddy’ app. The main objective was to describe self‐reported characteristics of headache and migraine (triggers, duration, frequency), treatment patterns and impact on daily activity in headache sufferers from Australia, Brazil, France, Germany and Japan. Data including demographics, self‐diagnosed episode type (headache/migraine), duration, potential triggers and impact on daily activity are reported. All analyses were exploratory and performed per country.ResultsSelf‐reported data were collected from 60,474 users between August 2016 and August 2018. Approximately 90% of users were females; >60% were aged 24–45 years. Over one‐third of users reported having two to five episodes of headache or migraine per month; impact included impaired concentration, being slower and missing work or social activities. Variations across countries were observed; within countries, episode characteristics were very similar for self‐diagnosed headache versus migraine.ConclusionsHeadache tracking was used to describe the experience, impact and self‐management approaches of migraine and headache sufferers in a real‐world setting. Headache disorders present a range of important issues for patients that deserve more study and reinforce the need for better approaches to management.

Mechanisms of change in acceptance and commitment therapy for primary headaches

AbstractBackgroundDespite the demonstrated effectiveness of behavioural headache interventions, it is not yet known which intervention processes account for treatment responses. Acceptance and commitment therapy (ACT), an emerging behavioural intervention for headaches, proposes psychological flexibility (PF) processes as the mechanisms via which intervention change occurs. This is the first study examining these processes of change variables on headache‐related disability and quality of life (treatment outcome).MethodsData originated from a Randomized Clinical Trial evaluating the efficacy of ACT for primary headaches. Ninety‐four individuals with primary headaches (M = 43 y; 84% females; M headache frequency/month = 9.30) were randomized to either an ACT‐based or a Wait‐list control group (N = 47 in each). Participants completed questionnaires related to their headache experiences and PF processes at pre‐ (T1), post‐treatment (T2), and 3‐month follow‐up (T3).ResultsFollowing a bootstrapped cross product of coefficients approach, results demonstrated mediating effects of headache acceptance, cognitive defusion, avoidance of headache, and mindfulness in the ACT group compared to control on parameters of headache‐related disability and quality of life at post and 3‐month follow‐ups.ConclusionsThese findings demonstrate that changes in certain PF processes lower disability and improve quality of life in headache sufferers, supporting that ACT works via its proposed mechanisms of change. Interventions for headache management may be optimized if they target increases in headache acceptance, defusion from thoughts, and mindfulness.SignificancePsychological flexibility (PF) guides the ACT approach, an emerging behavioral headache intervention that focuses on optimizing head pain adjustment via flexible responses to pain. It targets at increasing daily functioning rather than preventing or controlling headache episodes. Pain acceptance, cognitive defusion, and mindfulness act as processes of functional change in ACT, lowering disability and increasing daily functioning and quality of life. These components can upgrade the established effectiveness of behavioral headache interventions with personalized, modularized therapeutic targets that can help headache sufferers re‐establish optimal daily functioning even in fluctuating and persistent headache episodes.Trial registrationclinical trials.gov registry (NCT02734992).