Family and Headache by Donald B. Penzien, Ph.D. People who seldom have headaches often tend to assume that the chronic headache patient has a psychological problem rather than a medical or physical one. But the evidence supports the opposite conclusion. Despite the fact that they have chronic pain, most headache patients are quite well adjusted, and so are their families. As a psychologist in a headache clinic, I am less involved in treating maladjustment than in helping patients identify environmental, physical and social factors that trigger headache and then change their behavior to minimize the effects of these stresses. But severe, frequent headache can have an impact on the well-being of the family as well as the individual. In a minority of cases, most often those where the patient's pain is very disabling, the family can be significantly disrupted. In fact, studies have shown that in families where there is someone with severe disabling pain, spouses and children are more likely to be depressed themselves. And what's happening in the family can play a role in producing or alleviating headache. Even in otherwise well-adjusted families, there can be patterns of coping and relating to the headache sufferer that inadvertently reinforce, rather than relieve, headache pain. An important indicator that can help you determine if headache is creating problems in your family is the extent to which headache pain has become a major feature of your family interactions. For example, the husband of one patient would become very caring when his wife had pain, massaging her neck and being affectionate, yet was unavailable to her at any other time. A child prone to headache who finds himself in a stressful situation in school may kept home for days or even weeks at a time. By doing so, the child may avoid headache, but the parents may be reinforcing the link between school and headache. Think of headache as a response of the body to stress--which may be anything from exams to irregular sleep to particular headache-triggering foods. If instead of finding means to cope with the inescapable stresses such as school or work, you consistently encourage the family member to avoid them, you are reinforcing rather than challenging headache as a response to stress. The wife needing affection or the child dreading school do not want to have headache--yet headache has become powerfully associated with something very desirable and otherwise hard to get. The response of headache pain has been unwittingly reinforced. The appropriate response to the family member with headache lies somewhere between an overconcern that encourages avoidance and a "tough-it-out" attitude that makes no allowances for the reality of intolerable pain. Many studies have shown that patients with other types of chronic pain, such as a back disorder, receive more concern and caring from family members when they show greater pain. Yet for headache patients, the opposite is often true: family members are more likely to be angry and intolerant the more signs of pain the headache sufferer shows. These results are difficult to explain but are perhaps a consequence of the fact that our society is not very accepting of headache as a cause of disability. A family conference can be very helpful when the family is in conflict over how to treat the headache patient, or when the headache problem is becoming the center of family life. Often just one family meeting with the physician or counselor is enough. The family then gets the diagnosis and the treatment plan first hand, which helps them accept headache as a legitimate physical disorder. In more complex cases, a few brief conferences can be effective in helping families understand what their role might be in helping cope constructively. If the headache sufferer has been missing too much school or work, or has been receiving affection and attention solely on account of headache, the family can work together to set up a system in which successful coping with pain, not succumbing to pain, is rewarded. None of these changes is a miracle cure: The headache is still there and still potentially disabling. But there are no "side effects" for this kind of medicine. Dealing with these kinds of family difficulties is good for the whole family, even if the headache sufferer will still have headaches. (Donald Penzien, Ph.D., University of Mississippi Medical Center, Headache Clinic, Jackson, Mississippi) Headache, vol. 5, issue 3, September 1994. Reprinted from the web site of  the American Council for Headache Education (www.achenet.org)