Ke Kenneth Holroyd

• PhD
• Professor Emeritus at Ohio University

Acute medication adherence is essential to manage chronic, episodic disorders, including headache. This paper describes the development of a measure of acute medication self-efficacy for headache (AMSE-H). Phase 1: 14 AMSE-H items were generated through qualitative interviews with 21 patients and 15 clinical headache experts. Phase 2: Researchers s...

Objective This is a secondary analysis of a randomized clinical trial which aims to examine changes in cognitive and behavioral responses to migraine with cognitive behavioral treatment for migraine, preventive medication for migraine, and their combination, and the relationship between these changes and reductions in migraine-related disability.Ba...

We sought to examine the relationship of family history of headache and family history of psychiatric disorders on self-reported health care utilization tendencies for migraine treatment. Familial aggregation of both migraine and depression has been well established in the literature. Family history of headache and psychiatric disorders could influ...

This study aims to qualitatively examine the behaviors required to optimally use acute headache medication and the barriers to successful performance of these behaviors. The efficacy of drug treatment is partly determined by medication adherence. The adherence literature has focused almost exclusively on the behaviors required to optimally use medi...

M-health applications provide a unique new way to deliver healthcare. Developing m-health applications involves new challenges different from those encountered when developing traditional healthcare programs and e-health applications. This paper describes the development of an m-health application for behavioral migraine management, and presents le...

Mood and anxiety disorders are comorbid with migraine and commonly assumed to portend a poor response to preventive migraine therapies. However, there is little evidence to support this assumption. We examined impact of a mood and/or anxiety disorder diagnosis using American Psychiatric Association Diagnostic and Statistical Manual criteria on resp...

To assess the efficacy and safety of adding propranolol to topiramate in chronic migraine subjects inadequately controlled with topiramate alone. This was a double-blind, placebo-controlled, randomized clinical trial conducted through the National Institute of Neurological Disorders and Stroke Clinical Research Collaboration, expected to randomize...

Modern smart mobile devices offer media-rich and context-aware features that are highly useful for electronic-health (e-health) applications. It is therefore not surprising that these devices have gained acceptance as target devices for e-health applications, turning them into m-health (mobile-health) apps. In particular, many e-health application...

Modification of expectancies (headache self-efficacy and headache locus of control) is thought to be central to the success of psychological treatments for migraine. The purpose of this study is to examine expectancy changes with various combinations of Behavioral Migraine Management and migraine drug therapies. Frequent migraine sufferers who fail...

Are largely beneficial, but a lack of research leaves important clinical questions unanswered

We compared migraine features and acute therapy response in menstrually-related migraines (MRMs) and non-menstrually-related migraines (NMRMs). Women with frequent, disabling migraines were prospectively diagnosed with MRM according to the International Classification of Headache Disorders (ICHD-II; N = 107) criteria using a daily electronic headac...

To determine if the addition of preventive drug treatment (β blocker), brief behavioural migraine management, or their combination improves the outcome of optimised acute treatment in the management of frequent migraine. Randomised placebo controlled trial over 16 months from July 2001 to November 2005. Two outpatient sites in Ohio, USA. 232 adults...

Our recent feasibility study of a telephone-administrated Behavioral Migraine Management (BMM) program for teens revealed that while learning and improvements in migraine were encouraging, experience for teens could be further improved with on-demand access to BMM instruction and materials. To meet this demand, an iPhone application was developed t...

The Clinical Trials Subcommittee of the International Headache Society published its first edition of the guidelines on controlled trials of drugs in tension-type headache in 1995. These aimed ‘to improve the quality of controlled clinical trials in tension-type headache’, because ‘good quality controlled trials are the only way to convincingly dem...

This study examined if the presence of one or more psychiatric disorders influences headache treatment outcomes in patients in headache specialty treatment centers. Using a naturalistic, longitudinal design, 223 patients receiving preventive therapy for headache disorders completed 30-day daily diaries that assessed headache days/month and severity...

We evaluated two putative moderators of treatment outcome as well as the role of Headache Management Self-Efficacy (HMSE) in mediating treatment outcomes in the drug and non-drug treatment of chronic tension-type headache (CTTH). Subjects were 169 participants (M=38 yrs.; 77% female; M headache days/mo.=22) who received one of four treatments in th...

This study sought to determine if Whites and African-Americans respond similarly to headache treatment administered in 'real-world' headache specialty treatment clinics. Using a naturalistic, longitudinal design, 284 patients receiving treatment for headache disorders completed 30-day daily diaries that assessed headache frequency and severity at p...

Rural areas account for approximately 6% of AIDS cases in the United States. Many HIV-infected persons in rural areas live with elevated levels of psychiatric distress, suicidal ideation, and loneliness. This pilot study tested whether brief interpersonal psychotherapy delivered via telephone could reduce psychiatric distress among persons living w...

Given the limitations of conventional therapies and restrictions imposed on newer pharmacologic agents, there is an urgent need to develop efficacious and efficient treatments that teach patients behavioral self-management skills for relieving irritable bowel syndrome (IBS) symptoms and associated problems. Seventy-five Rome II diagnosed IBS patien...

This research characterized patterns and predictors of adherence to headache treatment appointments in patients presenting at headache specialty treatment clinics throughout Ohio. Participants were 186 patients (118 white, 68 African Americans, 89% female) in headache treatment clinics in Cincinnati, Cleveland, Columbus and Toledo, OH. The study us...

To examine the feasibility of administering behavioral migraine management training by telephone (TAT) and the acceptability of TAT to adolescents with episodic migraine. 34 adolescents (M = 14 years) with migraine (M = 3.6 migraines/month; M = 29.2 hours duration) were randomly assigned to a two-month telephone administered behavioral migraine man...

Migraine characteristics are associated with impaired functioning and quality of life (Fn/QoL), but the impact of other factors on Fn/QoL in headache patients is largely unexplored. We examined catastrophizing, comorbid anxiety/depression and migraine characteristics as related to Fn/QoL, and explored the consistency of these relationships across f...

Headache is a huge public health problem and migraine alone cost 27 billion Euros per year in Europe. It is therefore important how the health care service for headache patients is organised throughout the world. Patients seen at headache clinics are more severely affected than those seen in general practice, and headache clinics need to be familia...

Exteroceptive suppression of temporalis and masseter muscle activity was examined in young men with and without a parental history of hypertension. Recent clinical studies suggest that the second exteroceptive suppression period is attenuated in several chronic pain disorders and that this brainstem reflex may serve as a noninvasive index of endoge...

Much of the contemporary literature on headache disorders focuses on migraine headaches, despite the fact that tension-type headache (TTH) is highly prevalent and can be as debilitating as migraines. This article reviews the current literature on prevalence rates of psychiatric disorders in TTH populations, psychologic factors associated with TTH,...

Recent research on headache has focused on identifying the prevalence of psychiatric disorders in headache patients and discerning the impact of psychiatric comorbidity on treatment of headache. The presence of comorbid psychiatric disorders, especially anxiety and depression, in headache patients is now a well-documented phenomenon. Existing but l...

This study aimed to examine penetration of the blind in a randomized, placebo-controlled trial. Neurologists' ratings of improvement and medication side-effects, participants' ratings of improvement and daily diary recordings of headaches were assessed along with participants' and neurologists' guesses about treatment group placement in participant...

By 2015, the Centers for Disease Control and Prevention predicts that 50% of all cases of HIV/AIDS in the United States will be in persons 50 years of age or older. This pilot research tested whether a 12-session, coping improvement group intervention delivered via teleconference technology could improve life quality in 90 middle-age and older adul...

Behavioral interventions such as biofeedback training, relaxation training, and cognitive-behavior stress management therapy have been identified as efficacious treatments for migraine headache. These treatments, and the formats (clinic-based, limited-contact, and home-based) in which they are taught, are described in this article. Information abou...

Patient behaviors performed in the self-management of asthma have been investigated by use of black box theory as a model for examining behavioral change. Consequently, the context within which patients learn and perform processes of self-management has been ignored. The purpose of the present study was to investigate contextual and behavioral elem...

Trials that compare drug and behavior therapies or evaluate combination therapy raise special methodological issues. This article reviews these methodological issues and, where possible, offers guidelines for addressing them. Sources of bias in the selection and recruitment of participants and in the measurement of treatment outcomes are discussed....

Guidelines for design of clinical trials evaluating behavioral headache treatments were developed to facilitate production of quality research evaluating behavioral therapies for management of primary headache disorders. These guidelines were produced by a Workgroup of headache researchers under auspices of the American Headache Society. The guidel...

Patient behaviors performed in the self-management of asthma have been investigated by use of black box theory as a model for examining behavioral change. Consequently, the context within which patients learn and perform processes of self-management has been ignored. The purpose of the present study was to investigate contextual and behavioral elem...

The aim of this study is to examine the influence of depression on headache onset following laboratory stress and on psychophysiological variables associated with tension-type headaches (TTHs). Diagnostic interviews identified three groups: headache prone and depressed (HP/D, N = 13); headache prone not depressed (HP/ND, N = 22); and healthy contro...

This study examined factors associated with impaired quality of life and functioning in a sample of treatment-seeking adolescent migraineurs. Subjects.-The 37 participants were 51.4% female, and averaged 14.3 years of age and 4.1 migraines per month for the previous 36 months. The Migraine-Specific Quality of Life Questionnaire, questionnaire items...

In some individuals, chronic tension-type headache fails to respond to tricyclic antidepressant medications that often serve as first-line therapy. To evaluate the clinical efficacy of paroxetine hydrochloride for chronic tension-type headache not responding to amitriptyline hydrochloride. Open-label trial of paroxetine conducted at 2 outpatient si...

It is estimated that more than 30% of patients do not respond to pharmacologic interventions for headache. As a result, and to avoid potential side effects, patients have begun seeking nontraditional modes of therapy for the management of headache. Among the alternative therapies are behavioral treatments (relaxation therapy, biofeedback therapy, a...

J Fam Pract. 2002;51:142‐147. OBJECTIVE: This study's purpose was to identify the areas that people find most difficult in living with migraines and, in that regard, what kinds of assistance would be most helpful to them and to other people who have migraine headaches. STUDY DESIGN: Four focus groups, each consisting of 4 to 8 participants, were he...

We assessed the views of physicians interested in headache as to the diagnosis of the most commonly occurring and currently controversial headaches. The International Headache Society (IHS) classification system has received wide professional endorsement and considerable empirical support, but in the United States, their adoption by clinicians may...

Behavioral and psychologic factors in tension-type headache are reviewed with reference to pathophysiology, comorbid psychiatric disorders, headache triggers, and behavioral treatment, including the efficacy of behavioral treatments, brief minimal contact administration of behavioral treatment, therapeutic mechanisms underlying the effectiveness of...

This article updates earlier reviews of recurrent headache disorders published in 1982 and 1992, selectively reviewing research published since 1990. Current issues in assessment (headache diagnosis, psychophysiology, comorbid psychopathology, quality-of-life assessment, and new assessment technologies) and psychological treatment (efficacy, therap...

Critics have called into question findings from double-blind placebo-controlled studies because subjects are given drug administration instructions informing them of a placebo condition. The assertion that these drug administration instructions bias estimates of effectiveness has undergone surprisingly little empirical investigation. The primary ob...

This article updates earlier reviews of recurrent headache disorders published in 1982 and 1992, selectively reviewing research published since 1990. Current issues in assessment (headache diagnosis, psychophysiology, comorbid psychopathology, quality-of-life assessment, and new assessment technologies) and psychological treatment (efficacy, therap...

Abstract Rationale. Critics have called into question findings from double-blind placebo-controlled studies because subjects are given drug administration instructions informing them of a placebo condition. The assertion that these drug administration instructions bias estimates of effectiveness has undergone surprisingly little empirical investig...

This study's purpose was to identify the areas that people find most difficult in living with migraines and, in that regard, what kinds of assistance would be most helpful to them and to other people who have migraine headaches. Four focus groups, each consisting of 4 to 8 participants, were held. Discussions, which were recorded and organized acco...

Barton and Blanchard's report that multicomponent behavioral treatment fails to modify chronic daily headaches is discussed with reference to the effectiveness of behavioral and drug treatments for chronic tension-type headache, the distinction between chronic tension-type headache and chronic migraine, and the psychophysiology of episodic vs. pers...

Chronic tension-type headaches are characterized by near-daily headaches and often are difficult to manage in primary practice. Behavioral and pharmacological therapies each appear modestly effective, but data are lacking on their separate and combined effects. To evaluate the clinical efficacy of behavioral and pharmacological therapies, singly an...

Headache-specific self-efficacy refers to patients' confidence that they can take actions that prevent headache episodes or manage headache-related pain and disability. According to social cognitive theory, perceptions of self-efficacy influence an individual's adaptation to persistent headaches by influencing cognitive, affective, and physiologica...

We examined pericranial muscle tenderness and abnormalities in the second exteroceptive suppression period (ES2) of the temporalis muscle in chronic tension-type headache (CTTH; n = 245) utilizing a blind design and methods to standardize the elicitation and scoring of these variables. No ES2 variable differed significantly between CTTH sufferers a...

Objective.—To examine and compare central pain processing and modulation in young tension-type headache sufferers with that of matched healthy controls using an induced headache “challenge” paradigm. Background.—Recent research has suggested that abnormalities in central pain processing and descending pain modulation may contribute to chronic tensi...

Objectives.– To examine the psychosocial correlates of chronic tension-type headache and the impact of chronic tension-type headache on work, social functioning, and well-being. Methods.– Two hundred forty-five patients (mean age = 37.0 years) with chronic tension-type headache as a primary presenting problem completed an assessment protocol as par...

It is increasingly recognized that pain measures alone provide incomplete information about the impact of pain on functioning or quality-of-life. A wide range of measures that promise to provide additional information about the impact of pain on people's lives are thus coming into use. In order to clarify the construct of headache impact, we attemp...

Exteroceptive suppression (ES) of temporalis muscle activity has received recent attention as a method of investigating central mechanisms in the pathogenesis of chronic headache disorders. Unfortunately, the resolution of conflicting findings has been hampered by the use of different assessment and scoring methodologies across laboratories, which...

Na primeira parte desta revisão sobre terapêutica não-farmacológica das cefaléias, são discutidos os príncipios e a eficácia das principais formas de intervenção psicológica para enxaqueca recorrente e cefaléia tensional (técnicas de relaxamento ou de “biofeedback”e controle do estresse). Na segunda parte, são apresentados programas detalhados de t...

The aim of the present study was to examine the ability of pericranial muscle tenderness and the second exteroceptive suppression period to distinguish chronic tension-type headache sufferers, migraine sufferers, and controls in a young adult population utilizing a blind design. The second exteroceptive suppression periods were assessed using the m...

Therapeutic mechanisms hypothesized to underlie improvements in tension headache activity achieved with combined relaxation and eleclromyographic (EMG) biofeedback therapy were examined. These therapeutic mechanisms included (1) changes in EMG activity in frontal and trapezii muscles, (2) changes in central pain modulation as indexed by the duratio...

A multitrait-multimethod design was used to examine the convergent and discriminant validity of seven pain measures from three widely used self-report instruments designed to assess the sensory, affective and intensity dimensions of pain. The instruments were the McGill Pain Questionnaire, the Pain Perception Profile and Numerical Ratings. Three di...

Exteroceptive suppression of temporalis and masseter muscle activity was examined in young men with and without a parental history of hypertension. Recent clinical studies suggest that the second exteroceptive suppression period is attenuated in several chronic pain disorders and that this brainstem reflex may serve as a noninvasive index of endoge...

The second exteroceptive suppression of masseter muscle activity (ES2) and tenderness in pericranial muscles were evaluated in 112 young adults who met IHS criteria in the following diagnostic classifications: 31 chronic tension headache, 31 episodic tension headache, 33 migraine without aura and 17 migraine with aura. An additional 31 subjects ser...

Cystic fibrosis (CF) is a major health concern with respect to morbidity and mortality. A self-management program was developed and evaluated to determine how such an approach might reduce the impact of CF on patients and their families. Despite constraints imposed by the context within which the investigation was conducted, positive findings were...

This article evaluated the ability of propranolol to enhance results achieved with relaxation-biofeedback training. Thirty-three patients were randomized to relaxation-biofeedback training alone (administered in a limited-contact treatment format), or to relaxation-biofeedback training accompanied by long-acting propranolol (with dosage individuali...

Most people occasionally experience but are seldom disabled by headaches. However, epidemiological studies reveal that more than 8 million females and 2 million males are disabled with some frequency by migraine headaches alone (Stewart, Lipton, Celentano, & Reed, 1992). The number of new cases of disabling headaches each year has been estimated at...

A link between headache and depression has been noted in the literature for over 30 years. To date, however, studies investigating this relationship have ignored the potential impact transdiagnostic symptoms (i.e., symptoms indicative of both depression and headache) may have on correlations between measures of depression and measures of headache a...

This is the first in a series of three articles addressing nonpharmacologic therapies for management of recurrent migraine and tension-type headache. It provides an overview of the commonly employed nonpharmacologic therapies for recurrent headache, reviews scientific evidence of their efficacy, and identifies the psychosocial interventions that ha...

The finding that recurrent headache sufferers, particularly tension headache sufferers, obtain higher scores on psychological symptom measures than controls was replicated in 262 recurrent (tension, mixed, and migraine) headache sufferers and 26 controls. However, closer examination of the data revealed that psychological symptoms were elevated onl...