Chapter 13 - Somatoform disorders and headache

Summary

This chapter reviews the phenomenon of somatization as a ubiquitous process and the so-called somatoform disorders. General treatment principles hold true for the neurologist who suspects a conversion headache. Pain disorder and conversion disorder differ primarily in that the primary symptom in pain disorder is pain rather than symptoms in organs of special sense or voluntary motor function. Anticonvulsants are used as prophylactics in migraine treatments. Patients with hypochondriasis have a high risk of psychiatric comorbidity with the most common diagnoses being mood and anxiety disorders. Reviews of the treatment of somatoform disorders and of medically unexplained symptoms both conclude that cognitive behavioral therapy (CBT) is the treatment with the best-established evidence for effectiveness. The core elements for management of somatoform disorders and headaches include: patient education; collaborative approach; self-monitoring; problem-solving; cognitive restructuring; behavioral assignments and action plans; and breathing and relaxation training.