Recurrent Headache among Swedish Adolescents : Psychosocial Factors, Coping and Effects of Relaxation Treatment

Abstract: Overall aims of the present thesis were to study the prevalence and psychosocial impact of recurrent headache within a school population in comparison with other types of pain and to examine the use and efficacy of various coping strategies. Further aims were to compare the effects of relaxation treatment among adolescents with recurrent headache to a waiting-list control group, and finally to examine the efficacy of relaxation training administered in a school setting.From 8 schools, 793 adolescents were recruited to a questionnaire study. The results showed that headache is a very common health complaint particularly among girls. Subjects with frequent headache also reported higher levels of depressive symptoms, anxiety, functional disability and other types of recurrent pain, than those with infrequent headache.A Swedish version of the pain coping questionnaire (PCQ) was translated and administered to the same sample of 793 adolescents. Its psychometric properties were replicated and problem solving was regarded to be the most effective coping strategy.In a treatment study 36 subjects suffering from migraine and tension-type headache were randomized to either relaxation treatment or a waiting list control group. Results showed that half of the adolescents were clinically improved after treatment. In a final effectiveness study 63 subjects were randomized to one of two types of relaxation training, administered by school nurses. The results showed similar positive outcomes but small differences compared to a non-treated post hoc comparison group. Positive outcomes of relaxation treatment were predicted by one pain coping strategy, positive self-statements but also by higher functional disability before treatment.In conclusion, more active strategies such as positive self-statements and problem solving were found to co-vary with a better efficacy or outcome after relaxation training. A further exploration of how to optimize treatment for adolescent headache is warranted in future studies. Generally a broader perspective including social, psychological as well as biological factors could give more information on the complex mechanisms behind headache.