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Behavioral Facilitation of Medical Treatment of Headache: Implications of Noncompliance and Strategies for Improving Adherence


  • Jeanetta C. Rains PhD,

  • Donald B. Penzien PhD,

  • Gay L. Lipchik PhD

  • From the Center for Sleep Evaluation, Elliot Hospital, Manchester, NH (Dr. Rains); Head Pain Center, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS (Dr. Penzien); and St. Vincent Health Psychology Services, Erie, PA (Dr. Lipchik).

Address all correspondence to Jeanetta C. Rains, PhD, Center for Sleep Evaluation, Elliot Hospital, One Elliot Way, Manchester, NH 03103.


Clinical recommendations were gleaned from a review of treatment adherence published in the regular issue of Headache (released in tandem with this supplement). The recommendations include: (1) Nonadherence is prevalent among headache patients, undermines treatment efficacy, and should be considered as a treatment variable; (2) Calling patients to remind them of appointments and recalling those who miss a scheduled appointment are fundamentally the most cost-effective adherence-enhancing strategies, insofar as failed appointment-keeping acts as a ceiling on all future treatment and adherence efforts; (3) Simplified and tailored medication regimens improve adherence (eg, minimized number of medications and dosings, fixed-dose combinations, cue-dose training, stimulus control); (4) Screening and management of psychiatric comorbidities, especially depression and anxiety, is encouraged; (5) The concept of self-efficacy as a modifiable psychological process often can be employed to predict and improve adherence.