While there is the official definition of pain, we prefer “pain is what the patient says it is, and it’s as bad as the patient says it is.”

Being aware that there are cultural and ethnic differences in the perception and experience of pain can aid treatment.

Pain patients are often desperate, and search the internet for a cure, or seek alternative practitioners. We should not castigate them for doing so; they are just looking for answers.

When patients feel that they can actively help their headaches (“self-efficacy”), by medication or biofeedback or other means, it improves their sense of well-being.  Whether by taking a medication, watching triggers, exercising, or doing yoga, etc., increasing “self-efficacy” enhances outcomes.

We cannot promise patients that their headaches will improve with psychotherapy (as it often does not), but coping with headaches and the stresses that headaches produce is often improved with therapy.  Unfortunately, because of stigma, time, and money, only a small minority of patients will actually go to a therapist.  However, those that do go will usually benefit. Biofeedback is under-utilized and should be offered more often.     First published July 1, 2006, edited and re-written 2012   Lawrence Robbins, MD



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