This is a somewhat complex proposal consisting of 5 parts which contain a total of 15 studies. The major foci of the proposal are (1) to discover possible mechanisms ionvolved in the psychological treatment of headache; (2) to investigate possible psychological and cognitive mechanisms in th etiology of chronic headache and the relation of these mechanisms to treatment processes; (3) to extend prospective followup data collection on chronic headache patients treated with psychological techniques associated with their headache disorder; (4) to utilize the existing data base of the improved procedures for predicting treatment outcome an matching patients to treatments as well as identifying """"""""high risk"""""""" patients who are likely to do poorly with psychological treatments; and (5) to evaluate the addition of cognitive stress coping procedures to previously tested physiologicaly oriented treatmets such as relaxation and biofeedback. Two separate, but parallel and similar, studies with new patients are proposed to answer similar mechanisms questions for both vascular (migraine and combined migraine and tension) and tension headache. We will evaluate the possible role of expectancy factors and of regular monitoring of headache activity in the relaxation treatment of tension headache and in the treatment of vascular headache with thermal biofeedback combined with relaxation training through the controlled comparison of a credible attention placebo condition and a headache monitoring condition to our standard treatments. In each of these two studies, we will also evaluate the effect of adding cognitive stress coping training to our standard treatments. We will follow-up treated patients for one year to investigate maintenance of treatment effects. The third study with new patients will evaluate the role of home practice and its application in the biofeedback and relaxation treatment of vascular headache. Data for the remaining 12 proposed studies will come both from our existing data base and from additional data gathered in the new treatment studies.
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