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The severity model of chronic headache

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Conclusion

Better understanding of headache promises to improve understanding of how mind and body interact. Taken as a biomedical model, the traditional classification of chronic headache fails to capture the essence of the headache problem, the spectrum of presentations seen in clinical practice, and the heuristic nature of treatment. The severity model holds promise as a better representation of clinical experience. By itself, the model is merely descriptive, but it can be easily incorporated into a broader biopsychosocial model of illness. It encourages the physician to evaluate each patient across all the parameters that influence headache. Thus, it focuses more attention on the patient and less on illusory syndromes. The term “recurrent nonspecific headache” is often a more accurate appraisal of patients’ headache histories.

Primary care physicians have much to offer in improving understanding and treatment of patients with headache. Because they see patients first and can know patients well, primary care physicians have abundant opportunities to amplify research on the psychosomatic sources of headache, develop and refine the utility of the severity model, and elucidate the role of the physician — patient relationship as a specific form of treatment.

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  1. UW-CHS-J5/224, University of Wisconsin, 600 Highland Avenue, 53792, Madison, WI

    Norman M. Jensen MD, MS

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  1. Michael J. Smith MD
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Received from the section of General Internal Medicine, University of Wisconsin Medical Center, Madison, Wisconsin.

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Smith, M.J., Jensen, N.M. The severity model of chronic headache. J Gen Intern Med 3, 396–409 (1988). https://doi.org/10.1007/BF02595801

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