Living with chronic headache: a qualitative study exploring goal management in chronic headache.

OBJECTIVES: Effective goal management may potentially prevent or reduce disability in chronic pain. The aim of this study was to gain insight into the nature of goal management in the context of chronic headache (CH). METHODS: Interviews with 20 patients were conducted, coded, and analyzed using a combined data-driven and theory-driven approach. The dual process model (DPM) was used as a theoretical framework for this study. RESULTS: Participants used a combination of strategies to regain and maintain a balance between personal goals and resources available for goal pursuit. Furthermore, their retrospective reports indicated a development in strategy use of time. Three goal management phases were identified: (1) a "persistence phase," characterized by the use of "resource-depleting" assimilative strategies to remain engaged in goals, (2) a "reorientation phase" in accommodative strategies were used to regain balance, and (3) a "balancing phase" in which a combination of "resource-depleting" and "resource-replenishing" assimilative strategies was used to maintain balance. CONCLUSIONS: Goal management is a dynamic process that may contribute to the development of, and recovery from, headache-related disability. Rehabilitation services offered to individuals with CH should target this process to promote optimal functioning. Implications for Rehabilitation Individuals with chronic headache use assimilative and accommodative goal management strategies to be able to pursue personal goals despite the limitations of chronic headache. Before accommodating goals to the limitations of chronic headache, many patients go through a phase of persistence, characterized by the use of resource-depleting assimilative strategies. A reorientation phase, characterized by accommodation of goals to the limitations of chronic headache, allows patients to adopt a more balanced way of pursuing personal goals.

Impaired Mood in Headache Clinic Patients: Associations With the Perceived Hindrance and Attainability of Personal Goals.

BACKGROUND: Headache disorders are often accompanied by impaired mood, especially in the headache clinic population. There is a large body of literature demonstrating that an illness or disability may affect the way in which patients perceive their personal goals and that the perception that the attainability of goals is hindered by the illness is a risk factor for impaired mood. However, empirical evidence regarding the extent to which goals are hindered or less attainable as a result of a headache disorder, and how that is related to mood, is currently lacking. OBJECTIVE: The aim of this cross-sectional study was to examine associations between headache severity, goal hindrance and attainability, and mood in a headache clinic population. METHODS: The sample consisted of 65 adult patients seeking treatment at a tertiary headache clinic. Prior to their first appointment in the clinic, patients completed self-report measures of headache severity, goals and mood (PANAS). RESULTS: Higher self-reported headache intensity was associated with higher goal hindrance (r = .38, P = .004), whereas greater headache frequency was associated with lower goal attainability (r = .30, P = .022). Higher perceived goal hindrance was associated with lower positive mood (r = -.27, P = .032) and higher negative mood (r = .28, P = .027). Furthermore, lower perceived goal attainability was associated with higher negative mood (r = -.34, P = .007). Goal perceptions explained an additional 11.4% of the variance in positive mood (F = 3.250, P = .047 <.05) and 10.5% of the variance in negative mood (F = 3.459, P = .039) beyond the effect of age and headache severity. CONCLUSION: The results of this preliminary study suggest that perceptions of increased goal hindrance and decreased goal attainability may indeed be a risk factor for impaired mood in the headache clinic population and highlight the need for further, longitudinal research. Obtaining more insight into goal processes (eg, what types of goals are specifically disturbed, which goal adjustment strategies are (mal)adaptive) may help to identify ways to improve outcomes in the headache clinic population.