Table 1.

Components of headache-focused cognitive-behavioral therapy (CBT)

CBT Component	Explanation	Purpose
Diaphragmatic breathing	Slow the rate of breathing while engaging the diaphragm muscle during inhalation and exhalation	Decrease autonomic nervous system arousal associated with pain and psychological distress
Progressive muscle relaxation	Sequentially tense and relax major muscle groups	Decrease muscle tension and autonomic arousal that can contribute to pain
Guided imagery	Create a calming mental scene that utilizes primary senses	Decrease attention to pain, promote feeling of relaxation using imagination
Distraction	Intentionally engaging in valued and pleasant activities	Decrease attention to pain and increase participation in important activities despite pain
Lifestyle Management	Develop behavioral plans with patients and parents to maintain regular intake of food and water, healthy sleep practices, and regular exercise	Promote optimal autonomic nervous system regulation and prevention of headaches
Activity Pacing	Promote a balanced level of activity that incorporates scheduled rest breaks into daily schedule	Decrease the likelihood of headaches starting or worsening with activity
Thought Identification	Identify negative or problematic thoughts associated with pain or other symptoms	Increase awareness of relationships among thoughts, emotions, physical feelings, and behavior
Cognitive Restructuring	Discuss unhelpful thought patterns that can contribute to worsening pain or distress, and/or introduce cognitive strategies that challenge unhelpful thoughts or predictions	Modify unhelpful patterns of thinking to identify realistic and balanced alternatives that reduce pain and distress, and promote optimal daily functioning