The purpose of this study is to determine if Minuchin, Rossman and Baker's Family Systems Theory (1978) describes the maintenance of headache pain in adults. The proposed research will assess the marital transactional patterns of chronic headache patients and their spouses prior to pain control treatment, posttreatment and 3 months follow-up. Headache pain perceptions will be measured at these time intervals, and the relationship between pain perceptions and marital transactional patterns will be explored. Pain perceptions include: pain sensation, affectivity, evaluation, intensity, frequency, duration, severity, and disability. Marital transactional patterns include: marital cohesion, adaptability, consensus, satisfaction, affection, conflict resolution, and sexual relationship. The following hypotheses will be tested: 1. Chronic headache patients in balanced marriages will report an average improvement in their pain perceptions at posttreatment and at 3 months follow-up. 2. Chronic headache patients in extreme marriages will report less average improvement in their pain perceptions at posttreatment and at 3 months follow-up, than patients in balanced marriages. 3. Three types of chronic headache patients in extreme marriages will be identified based on changes in pain perceptions at posttreatment and at 3 months follow-up: a) Some patients will report improvement at both time points; b) Some patients will report improvement at posttreatment, but will not sustain these changes at 3 months follow- up; c) Some patients will not report improvements at either time point. 4. Marital cohesion, adaptability and satisfaction will be positively correlated with patients' average pain perceptions over time. 5. Marital conflict resolution, adjustment and sexual relationship will be negatively correlated with patients' average pain perceptions over time. 6. Marital cohesion, adaptability and satisfaction will be positively correlated with the changes in patients' pain perceptions over time. 7. Marital conflict resolution, adjustment, and sexual relationship will be negatively correlated with the change in patients' pain perception over time. 8. Patients who report improvement in pain perceptions over time will also tend to report improvement in marital cohesion and adaptability overtime. Data will be collected from a systematic probability sample of 200 chronic headache patients and their spouses. The research design is a one group, pretest with posttests at 2 time periods. These instruments will be used: Dyadic Adjustment Scale, Marital Satisfaction, Conflict Resolution, Sexual Relationship, Family Adaptability and Cohesion Scale II, Family Satisfaction, questions from the McGill Pain Questionnaire and questions measuring pain perceptions. Data analyses will include descriptive statistics, ANOVAs, Pearson Correlation Coefficients, repeated measure MANOVAs, and cluster analysis. Nurses will learn whether Minuchin's Family Systems Theory can explain why some adult chronic headache patients do not respond to pain control treatment. Results of this study will be used for development of nursing interventions to assist chronic headache patients and their spouses.
