A Case Study

• Information gathered at the evaluation:
Sandy has had severe headaches for many years. She has tried 'everything' and nothing has provided lasting relief. She is has grown children and has been the primary caretaker for a disabled relative. She has a 'background' headache just about everyday and migraines and tension headaches several times a week. She knows she clenches her teeth at night but doesn't think she does during the day. Sandy has a very active life in spite of her chronic headaches. She reports that she often overrides how badly she feels in order to get to do anything. Her description of herself reveals that she has very high expectations of herself and puts everyone else's needs ahead of her own.

• Beginning sessions - headache frequency, low grade everyday, migraines 3-4 per week. As her first homework assignment she was asked to practice dropping her shoulders frequently throughout the day AND armed with the information that her teeth should never touch unless she is chewing or swallowing, she was asked to check to see what position her teeth were in as often as she could.

• Midway sessions - headache frequency, 3 in one week. After the first week, Sandy reported noticing that her shoulders were always up around her ears when she checked. But, although she knew she clenched her teeth at night she steadfastly denied doing it during the day. Toward the 5 week, she was noticing how her body was responding to stress and was experiencing fewer headaches of less intensity. She also noticed that during a week long visit from a favorite relative, she had been headache free!

• End session - headache frequency, 2 in two weeks. Sandy realized at the next to last training session that she was clenching her teeth during the day particularly while at the computer. Not only that, she noticed that her jaw muscles were sore most of the time which is a sure indication of clenching. She was amazed that she could be experiencing so much discomfort without 'realizing it'. Now that she has become so aware she will be able to notice much more easily when she is clenching and be able to stop. If she does this long enough the habit will reverse itself. It will now feel uncomfortable to clench and normal not to.

Sandy's headache type is not typical because she came into the training experiencing low grade headaches almost all the time. The type of headaches that respond the best are tension or migraine headaches that are more frequent that once a month. Cluster headaches, and constant headaches are not as responsive to this approach. Despite that, she was able to significantly reduce the frequency, duration and intensity of her headaches. Because the behavioral approach is a training, not a cure, as long as Sandy applies what she has learned she can expect to continue to improve.