377 Behavioral Self-management in an Inpatient Headache Treatment Unit: Increasing Adherence and Relationship to Changes in Affective Distress F. Hoodin, PhD; B.J. Brines, PhD; A.E. Lake III, PhD; J. Wilson, MS; J.R. Saper, MD, FACP Objective.–To evaluate prospectively the contribution of a psychological self-management program to the amelioration of headache-related distress of patients with intractable migraine treated in a comprehensive, multi- disciplinary, inpatient program. Background.–Previous research has shown the effectiveness of this overall inpatient program but did not ex- amine the relationships between the use of relaxation and other headache-related behavioral factors. Methods.–Data from 221 admissions to a Commission on Accreditation of Rehabilitation Facilities-accredited, nationally recognized, inpatient treatment unit were analyzed for the current study. On admission and on discharge (average length of stay, 12.9 days), subjects completed a 7-day retrospective, self-report questionnaire assessing health behavior compliance and emotional factors. The intervention consisted of intensive medical therapy in ad- dition to cognitive-behavioral treatment delivered in a group setting. Results.–Adherence increased significantly for relaxation practice and life-style modifications of diet, exer- cise, and sleep regulation for headache prevention ( P  .00001). Beck Depression Inventory scores decreased sig- nificantly ( P  .00001), and a greater decrease in depression by the end of the program was reported by subjects who practiced relaxation most compared with those who practiced relaxation least. Conclusions.–Low baseline adherence rates for health behavior increased significantly during the final week of inpatient treatment. Behavioral self-management variables, not headache reduction, were significantly associ- ated with patients’ reduction in affective distress. Key words: migraine, chronic daily headache, relaxation, inpatient, depression Abbreviations: BDI Beck Depression Inventory (Headache 2000;40:377-383) The objective of the current study was to evalu- ate prospectively the contribution of a psychological self-management program to the amelioration of headache-related distress of patients with intractable migraine who were being treated in a comprehensive, multidisciplinary, inpatient program. The inpatient treatment program combines state-of-the-art inten- sive medical management and psychological inter- vention, with the promotion of the patient’s self- responsibility for optimal health behavior. Previous research has shown the effectiveness of this overall inpatient 1 and outpatient program 2 but did not exam- ine the relationships between the use of relaxation and other headache-related behavioral factors. In outpatient settings, previous research has clearly demonstrated the contribution of relaxation and other cognitive-behavioral variables to the con- trol of headache. 3 A smaller body of literature has also provided evidence that treatment in groups is no From the Head Pain Treatment Unit at Chelsea (Mich) Com- munity Hospital. Dr. Hoodin and Ms. Wilson are also affiliated with Eastern Michigan University, Ypsilanti; Dr. Brines with the University of Michigan Medical Center, Ann Arbor; and Drs. Lake and Saper with the Michigan Head Pain and Neuro- logical Institute, Ann Arbor. Address all correspondence to Dr. F. Hoodin, Department of Psychology, Eastern Michigan University, 537 Mark Jefferson Hall, Ypsilanti, MI 48197. Accepted for publication December 13, 1999.