Future Directions in Behavioral Headache Research: Applications for an Evolving Health Care Environment


  • Donald B. Penzien PhD,

  • Jeanetta C. Rains PhD,

  • Gay L. Lipchik PhD,

  • Robert A. Nicholson PhD,

  • Alvin E. Lake III PhD,

  • Karl G. Hursey PhD

  • From the Department of Psychiatry and Human Behavior, and Director, Head Pain Center, University of Mississippi Medical Center, Jackson, MS (Dr. Penzien); Clinical Director, Center for Sleep Evaluation, Elliot Hospital, Manchester, NH, and Adjunct Assistant Professor, Department of Psychiatry, Dartmouth Medical Center, Lebanon, NH (Dr. Rains); Director, St. Vincent Health Psychology Services, Erie, PA (Dr. Lipchik); Assistant Professor, Department of Community & Family Medicine, Saint Louis University School of Medicine, and Research Psychologist, Mercy Health Research/Ryan Headache Center, St. Louis, MO (Dr. Nicholson); Director, Behavioral Medicine Division, Michigan Head Pain and Neurological Institute, Ann Arbor, MI (Dr. Lake); HealthSouth MountainView Regional Rehabilitation Hospital, Morgantown, WV (Dr. Hursey).

Address all correspondence to Dr. Donald B. Penzien, Professor and Director, Head Pain Center, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216.


Three decades of research has produced effective behavioral treatments for migraine and tension-type headache, yet the full fruition of this research has not been realized. Further development and dissemination of behavioral treatments is needed to impact the large numbers of those with headache who potentially could benefit from these interventions. At the same time, an evolving health care environment challenges researchers and providers to employ greater efficiency and innovation in managing all chronic disorders. Hopefully, the recently published clinical trials guidelines for behavioral headache research will serve as a catalyst for production of quality empiricism that, in turn, will generate enhanced behavioral strategies and will optimize health care resource utilization. This article describes 10 areas of critical needs and research priorities for behavioral headache research, including: replication and extension of seminal studies using improved methodology; analysis of barriers to implementation of behavioral treatments; development of referral and treatment algorithms; behavioral compliance facilitation with medical interventions; development of a headache self-management model; integration of behavioral intervention within traditional medical practice; identification and management of comorbid psychopathology among headache patients; prevention of disease progression; analysis of behavioral therapeutic mechanisms, and development of innovative treatment formats and applications of information technologies.