Home-based, largely self-administered, non-pharmacological treatments for chronic headache, based on instruction manuals and sets of autiotapes will be compared, in controlled studies, to comparable office-based treatments in terms of efficacy, or the extent of headache reduction, and also in terms of cost effectiveness, or the extent of headache reduction per unit of therapist time. Two separate, but parallel and highly similar, studies are proposed: For tension headache, after a one month baseline of daily headache recording we will randomly assign 40 patients to one of two conditions to compare our standard office-based relaxation training program to similar training conducted largely at home by means of instruction manuals and audiotapes. For vascular headache (migraine and combined migraine and tension headache) again after a one-month baseline, we will randomly assign 42 patients to one of two conditions: An office-based treatment which combines relaxation training and thermal biofeedback or a comparable home-based program. We use a combined treatment for two reasons: our own data point out the advantage of adding thermal biofeedback to relaxation training, especially for combined headache; and it is practical to add thermal biofeedback to a home treatment regimen through the use of very simple devices. Comparisons will be made in each study of efficacy for headache reduction and cost effectiveness. We will follow-up the patients treated in both studies for at least a year to investigate maintenance of treatment effects. In both cases the home-based treatments are designed for practical adoption in medical practices, through providing for the combination of some limited professional instruction in the office with the bulk of treatment being self-administered. Should the home-based, self-administered treatment packages be as cost-effective, or more cost-effective, than individual office-based treatment, it could lead to overall reduction in health care costs for this large scale, minor health program. Moreover, it could also provide a ready alternative, or adjunct, to pharmacological treatment forthe chronic headache sufferer. Finally, we propose to extend the follow-up data collection on our initial cohort of chronic headache sufferers treated with relaxation, and possibly biofeedback, to at least two years to add to knowledge in this area.
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