Behavioural approach to the "difficult" patient

The challenges in managing the more complicated headache patients are discussed and reviewed in this article. These patients often have chronic daily headache or high-frequency disabling headache. Some of these patients have problems adhering to treatment regimens, which may reduce treatment efficacy and sometimes lead to medication overuse. Medication overuse itself may induce a transformation of headache to daily by reducing the effectiveness of acute and preventive therapies. Biobehavioural factors are important in the assessment and treatment of headache patients. Also the biobehavioural aspects involved in headache patients will provide a model for integration of behavioural therapies into clinical practice. The purpose of this article is to highlight behavioural/psychological factors important to consider for clinicians managing this particular category of patients.