Lipchik Gay L, Smitherman Todd A, Penzien Donald B, Holroyd Kenneth A
Saint Vincent Health Psychology Services, Erie, PA 16502, USA.
Headache. 2006 Oct;46 Suppl 3:S119-32. doi: 10.1111/j.1526-4610.2006.00563.x.
Recent research on headache has focused on identifying the prevalence of psychiatric disorders in headache patients and discerning the impact of psychiatric comorbidity on treatment of headache. The presence of comorbid psychiatric disorders, especially anxiety and depression, in headache patients is now a well-documented phenomenon. Existing but limited empirical data suggest that psychiatric comorbidity exacerbates headache and negatively impacts treatment of headache. Problematically, these findings have not yet eventuated in improved treatments for individuals suffering from both headache and a psychiatric disorder(s). The present article is an attempt to describe the application of cognitive-behavioral therapies (CBT) for depressive and anxiety disorders to headache patients who present with psychiatric comorbidity. We discuss the origins of the chronic care model in relation to CBT, review basic cognitive-behavioral principles in treating depression and anxiety, and offer clinical recommendations for integrating CBT into existing headache treatment protocols. Directions for future research are outlined, including the need for treatment outcome studies that examine the effects of treating comorbid psychiatric disorders on headache (and vice versa) and the feasibility of developing an integrated CBT protocol that addresses both conditions simultaneously.
近期关于头痛的研究聚焦于确定头痛患者精神障碍的患病率，并识别精神共病对头痛治疗的影响。头痛患者中存在共病精神障碍，尤其是焦虑和抑郁，如今已是一个有充分文献记载的现象。现有的但有限的实证数据表明，精神共病会加重头痛，并对头痛治疗产生负面影响。问题在于，这些发现尚未带来针对同时患有头痛和精神障碍的个体的改进治疗方法。本文试图描述将用于治疗抑郁和焦虑障碍的认知行为疗法（CBT）应用于伴有精神共病的头痛患者的情况。我们讨论了与CBT相关的慢性病护理模式的起源，回顾了治疗抑郁和焦虑的基本认知行为原则，并为将CBT纳入现有的头痛治疗方案提供临床建议。概述了未来研究的方向，包括开展治疗结果研究的必要性，即研究治疗共病精神障碍对头痛的影响（反之亦然），以及制定同时解决这两种情况的综合CBT方案的可行性。
