Psychological factors such as attitudes, beliefs, and motivation level may affect adherence with nonpharmacologic therapies for headache, according to a study published in Headache.

For this narrative review, an interdisciplinary team of researchers conducted literature searches for keywords such as “headache” or “migraine” and “adherence” or “compliance.”

A patient’s set of attitudes and beliefs was identified as a primary barrier to treatment adherence. Perception of treatment acceptability was identified as a modifiable target to enhance adherence with nonpharmacologic treatment. Patients in the precontemplation or contemplation stages were found to be less likely to adhere with treatment than those in the preparation, action, or maintenance stages of the Stage of Change Model. 

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Patients who were unaware of headache triggers were found to be less likely to address these factors, resulting in suboptimal treatment outcomes. Individuals who had a low level of perceived control over their life events and low self-efficacy were also found to be less likely to adhere with treatment and cope with the outcomes.

The researchers proposed several strategies to help clinicians improve adherence in patients with headache who exhibit identified barriers to treatment. They suggest adapting treatment to a patient’s unique characteristics, level of severity, and readiness to change. They also recommend conducting motivational interviewing; educating patients on trigger identification, monitoring, and management; and using personality assessment tools.

“Attention to the variety of factors that influence adherence is paramount to headache practitioners in promoting treatment adherence and ultimately treatment outcome,” concluded the study authors.

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Matsuzawa Y, Lee YSC, Fraser F, et al. Barriers to behavioral treatment adherence for headache: an examination of attitudes, beliefs, and psychiatric factors [published online October 27, 2018] Headache. doi: 10.1111/head.13429