Behavioral self-management in an inpatient headache treatment unit: Increasing adherence and relationship to changes in affective distress

Objective.-To evaluate prospectively the contribution of a psychological se lf-management program to the amelioration of headache-related distress of p atients with intractable migraine treated in a comprehensive, multidiscipli nary, inpatient program. Background.-Previous research has shown the effectiveness of this overall i npatient program but did not examine the relationships between the use of r elaxation and other headache-related behavioral factors. Methods.-Data from 221 admissions to a Commission on Accreditation of Rehab ilitation Facilities-accredited, nationally recognized, inpatient treatment unit were analyzed for the current study. On admission and on discharge (a verage length of stay, 12.9 days), subjects completed a 7-day retrospective , self-report questionnaire assessing health behavior compliance and emotio nal factors. The intervention consisted of intensive medical therapy in add ition to cognitive-behavioral treatment delivered in a group setting. Results.-Adherence increased significantly for relaxation practice and life -style modifications of diet, exercise, and sleep regulation for headache p revention (P<.00001). Beck Depression Inventory scores decreased significan tly (P<.00001), and a greater decrease in depression by the end of the prog ram was reported by subjects who practiced relaxation most compared with th ose who practiced relaxation least. Conclusions.-Low baseline adherence rates for health behavior increased sig nificantly during the final week of inpatient treatment. Behavioral self-ma nagement variables, not headache reduction, were significantly associated w ith patients' reduction in affective distress.