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Barriers to Behavioral Treatment Adherence for Headache: An Examination of Attitudes, Beliefs, and Psychiatric Factors

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Nonpharmacological interventions, such as biofeedback, cognitive behavioral therapy, and relaxation techniques are Level‐A evidence‐based treatments for headache. The impact of these interventions is often equivalent to or greater than pharmacological interventions, with fewer side effects.┬áDespite such evidence, the rate of participation in nonpharmacological interventions for headache remains low. Once obstacles to optimizing use of behavioral interventions, such as local access to nonpharmacological treatment and primary headache providers are traversed, identification of barriers contributing to low adherence is imperative given the high levels of disability and cost associated with treating headache disorders. In this review of factors in adults associated with underuse of nonpharmacological interventions, we discuss psychological factors relevant to participation in nonpharmacological treatment, including attitudes and beliefs, motivation for change, awareness of triggers, locus of control, self‐efficacy, acceptance, coping styles, personality traits, and psychiatric comorbidities associated with treatment adherence. Finally, future prospects and approaches to optimizing treatment matching and minimizing adherence issues are addressed.
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Keywords: barriers to adherence; headache; nonpharmacological interventions; psychological factors

Document Type: Review Article

Publication date: January 1, 2019

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