Psychological factors of illness perpetuation in patients with headaches

Abstract

The paper presents the systematization of studies of the psychological factors of the headache perpetuation from the perspective of the cultural-historical approach in psychosomatics. Headache perpetuation is understood as a process that includes not only medical criteria (symptom consolidation), but also psychological ill-being associated with the illness (decreased quality of life and social functioning). Aсcording to a proposed working model, illness representation in patients with headache could be described by interrelated blocks of (1) perception of pain and pain sensitivity (2) emotional and cognitive pain appraisal, (3) coping with pain. Decline in the patient's quality of life and functioning is related to specific peculiarities in each block. Based on review of empirical studies we demonstrate that both low and high pain sensitivity could be consequences of emotional context of situation of pain, cultural peculiarities of pain perception or personality traits. Changing of sensitivity could be a risk factor of chronification. High anxiety sensitivity, pain-related fear, external locus of treatment-related control and low sense of authorship in patients with headaches are related to disturbances in emotional and cognitive appraisals of pain. Emotional and cognitive usually take place simultaneously. Coping with illness can be disturbed at levels of coping-strategies and motivation of treatment. Use of maladaptive copings and rigid adherence to some strategies are risk factors for pain perpetuation. Narrowing of motivation sphere and using symptom for communication and manipulation can be marker of hypochondrization. Based on the identified factors of headache perpetuation possible targets of psychotherapy, diagnostic and prevention of chronification are discussed.