Non-headache Controls Research Articles

Effect of movement and position on muscle activity in tension headache sufferers during and between headaches

This paper presents the results of two studies. In the first, 20 tension headache subjects were evaluated in both a headache and non-headache state on bilateral trapezius and unilateral frontalis electromyographic activity during six positions: standing, bending from the waist, rising, sitting with back unsupported, sitting with back supported, and prone. Results indicated no effect of headache state on either measure. In a second study, 11 of the tension headache sufferers in Study One and 11 age-matched controls were compared on the same measures (controls were assessed two times, with a one-week duration separating evaluations). Results indicated a diagnosis by position interaction, with posthoc tests revealing the muscle activity of tension headache sufferers to be considerably higher during the prone position than that of non-headache controls. Non-significant trends were found when examining the data for clinically significant abnormalities (90% of the headache sufferers were found to have significant clinical abnormalities).

Prediction of Migraine Using Psychophysiological and Personality Measures

The topics of interest in this study are whether migraine patients exhibit a stereotypic reaction to a stressful stimulus which is different from the reaction of nonheadache controls and whether it is possible to predict headache activity within the migraine population. Our study population comprised 37 female migraine patients and 34 matched controls. Heart rate, skin conductance, pulse amplitude of the temporal artery and an EMG of the temporal muscle were registered during a baseline situation and during a mental stressor. In addition, state anxiety, trait anxiety, facilitating anxiety and stress tolerance were assessed. Migraine patients reported higher levels of trait anxiety, greater fear of failure, lower stress tolerance and higher levels of state anxiety than nonheadache controls. Physiological baseline levels and stress reactions did not differ between migraine patients and controls. Linear combinations of psychological and psychophysiological data sets did not show an acceptable degree of accuracy in the classification of individual response profiles into groups. Within the migraine group, 54% of the average duration of migraine attacks and 33% of the variation in average maximum headache intensity could be explained by a combination of psychological, psychophysiological and socio-demographic variables. It is concluded that measures from both the psychological and the physiological domain should be included when studying the effects of stress in migraine.

Migraine Patients Cognitively Impaired?

In order to investigate the hypothesis that migraine has a detrimental effect on cognitive functioning, 37 female migraine patients and 34 nonheadache female controls underwent a battery of neuropsychologic tests. No significant difference in test performance between groups was found. There was no relation between the length of migraine history or medication use and the level of impairment of cognitive abilities. The patient and control groups differed significantly on several self-report measures known to interfere with performance. Patients reported higher trait and state anxiety levels, higher debilitating anxiety and state depression, and less vigor. Statistical correction for these variables, however, did not result in significant group differences of cognitive performance. The results suggest that the general population of female migraine patients show no indication of cognitive impairment.

Assessment of dietary risk factors in chronic headache

An investigation of the awareness level and potential impact of dietary risk factors on chronic headache patients revealed that (1) approximately 75% of the 130 patients in this study stated they were aware of possible food-intake/headache connections, (2) less than half reported being informed of this relationship by medical professionals, and (3) the awareness of this nutritional information did not prompt changes in subjects' dietary practices. The comparison of food-intake patterns of the headache patients and nonheadache control group revealed a significant difference only on red wine consumption.

Oral habits in common between tension headache and non-headache populations.

Previous research has suggested a relationship between migraine pain and oral habits. The present study was designed as a replication of a prior study that found self-reported higher frequencies of certain oral habits in migraine as opposed to tension headache and non-headache groups. Three groups of subjects (common migraine, tension headache and non-headache) were given a single questionnaire in which five oral habits (i.e. teeth clenching, jaw jutting, cupping the chin in the hand, and resting the right and left side of the face on the hand) were rated on a 0 (not at all) to 10 (almost always) scale. Significant main effects were obtained for groups and oral habits in a 3 (groups) X5 (oral habits) ANOVA. Post hoc Tukey tests revealed the common migraine group reported significantly more frequent oral habits than did the tension headache group. The non-headache control group did not differ significantly from either headache group. Discussion focuses on the need for continued research in this area.

Psychological functioning of children who have recurrent migraine

Thirty-two children experiencing recurrent migraine, aged 8–17, were compared to 32 non-headache peer controls matched for age, sex, and social class. Each child completed an extensive battery of psychological tests, which consisted of 1. (1) the Children's Depression Inventory (for children aged 8–13) or the Beck Depression Inventory (for children 14 and above), 2. (2) the State-Trait Anxiety Inventory for Children (ages 8–12) or the State-Trait Anxiety Inventory, Form X (ages 13 and above), 3. (3) the Children's Depression Rating Scale, 4. (4) the Personality Inventory for Children, 5. (5) the Child Behavior Checklist, 6. (6) the Psychosomatic Symptom Checklist, SUNYA Revision, 7. (7) the Children's Social Readjustment Rating Questionnaire, 8. (8) the Wide Range Achievement Test for Reading, and 9. (9) the Peabody Picture Vocabulary Test, Form L. Children with migraine revealed higher scores on all scales measuring depression and somatic complaints; adolescent headache sufferers also revealed increased levels of trait anxiety. Older male headache sufferers revealed the poorest overall level of adjustment as reflected by scores on the Adjustment scale of the Personality Inventory for Children. It was argued that the psychological differences were most likely a consequence of the migraineurs having to live with frequent, unpredictable attacks of intense pain. However, the correlational nature of this study does not make it possible to rule out alternative explanations.

Electromyographic and vasomotor activity in tension, migraine, and combined headache patients: The influence of postural variation

Electromyographic (EMG) and temporal artery vasomotor activity was evaluated in three groups of headache patients (tension, migraine and combined) and nonheadache control subjects while in reclining, sitting and standing positions. Analysis of the EMG data revealed that at all measurement sites (bilateral frontalis, bilateral trapezius) the three headache groups demonstrated significantly higher levels than the nonheadache group but did not differ from each other. A secondary analysis of the trapezius EMG data revealed that a large percentage of headache patients had “normal” EMG levels in the reclining position but showed abnormalities in the sitting and standing positions. Analysis of the left temporal artery vasomotor activity revealed that all three headache groups vasoconstricted to a significantly greater extent than the nonheadache group in the sitting and standing positions. However, a diagnosis by position interaction was found for the right temporal artery with the migraine group demonstrating a unique pattern of activity.

Implications of Individual Differences in Vascular Reactivity for the Management of Migraine

The view that dilatation of scalp arteries is a major source of pain in migraine was examined in a series of clinical and psychophysiological investigations. Examination of patients during unilateral migraine or tension-vascular headache demonstrated evidence of extracranial vasodilatation in only a minority of patients. Studies of psychophysiological reactivity indicated that the amplitude of superficial temporal artery pulsations increased more on the side habitually affected by headache than on the non-symptomatic side after light exercise, and increased more readily in migrainous subjects than in non-headache controls during psychological stress. In patients who had previously shown thermographic signs of an increase in blood flow at the site of headache, scalp arteries dilated readily to mental arithmetic stress and exercise. Although extracranial vasodilatation sometimes contributes to migraine, it does not appear to be the primary source of pain in the majority of patients. Regulation of scalp artery diameter may be most effective in the subgroup of patients whose scalp arteries contribute to pain.

A quantitative assessment of photophobia in migraine and tension headache.

SYNOPSISIntensity of photophobia in dull and bright light was assessed in 39 migrainous patients and 15tension headache sufferers during headache, and in 20 nonheadache control subjects. In 24 patients,measurements were repeated during the headache‐free interval. Subjective estimates of glare andlight‐induced pain were greatest in patients with migraine at the time of examination, but ratings bytension headache sufferers also exceeded control ratings at most levels of illumination. In 19 of 25patients with unilateral headache, light‐induced pain was greater on the symptomatic side. During theheadache‐free interval, glare ratings in dull and bright light, and pain ratings in bright light, weregreater in headache‐prone patients than in nonheadache controls. Sensitivity to glare could thusform part of a general hyperexcitability of the special senses, while bright light appears to exacerbatepain resulting from activation of trigeminal pain pathways during headache.

The Effect of Postural Variation on the Electromyographic Evaluation of Tension Headache and Nonheadache Control Participants

SYNOPSISTwelve tension headache patients and 12 nonheadache controls participated in an electromyographic (EMG) evaluation in which measurements were obtained from horizontal frontalis and bilateral trapezius placements. The evaluation was conducted while the participants were in reclining, sitting and standing positions. The results demonstrated higher frontalis EMG levels for the headache participants. However, contrary to prediction, the headache participants showed no greater EMG elevations in the trapezius musculature while sitting or standing as compared to the nonheadache controls.

Subjective stress sensitivity and physiological responses to an aversive auditory stimulus in migraine and control subjects.

Subjective stress sensitivity and physiological parameters were compared between 24 migraine subjects and 24 matched headache-free controls during a multifrequency 85-dB (A) aversive auditory stressor and during a recovery period. Measures consisted of frontalis EMG, temporal artery blood volume pulse, heart rate, a stress sensitivity questionnaire, stress reaction during the stress-expectation period, and ratings of noise aversiveness. Migraine subjects showed a higher level of general stress sensitivity, increased situational stress sensitivity, and higher ratings of noise aversiveness; this supports the general notion that migraine sufferers are psychologically more sensitive toward stress stimulation than nonheadache controls. Physiologically, the migraine subjects differed from the control group only with regard to the temporal blood volume pulse during stress stimulation; this finding is consistent with Wolff's weak-link theory.

Obsessions and compulsions in three kinds of headache sufferers: Analysis of the maudsley questionnaire

It has long been believed, especially by psychodynamic theoreticians, that characterological personality characteristics of headache sufferers have contributed to the genesis of the disorder. The most frequently used descriptor of the migraineous personality is that of obsessiveness, compulsivity and rigidity. Unfortunately, there has been no empirical research on this factor, merely unsystematic clinical impressions. The present study assessed the relationship between obsessions and compulsions in three kinds of headache sufferers and non-headache controls, using a well-designed and validated scale. Results indicated few differences between the groups. Unlike our previous research, the concept of a ‘pain density’ function was not supported. These data, on the whole, seem to support the preponderance of data in the area of headache and other dimensions of personality: there is no clearly differentiated migraine or headache personality.

Headaches and heart disease: the lack of a positive association.

SYNOPSISIn order to investigate the relationship between headaches and cardiovascular disease, 200 individuals with recurrentidiopathic headaches were compared with age‐ and sex‐matched controls for the prevalence of cardiovasculardiagnoses and electrocardiographic (ECG) abnormalities. Only hypertension was diagnosed more frequently in theheadache group; ischemic heart disease and valvular lesions were diagnosed equally in some cases and controls, aswere rhythm disturbances. Matched ECG's were available in 161 pairs. Ischemic ECG changes were more frequent inthe controls than the headache cases. There were no other differences in ECG findings. This study fails to show apredilection for cardiovascular diseases, other than hypertension, in individuals with headaches. Ischemic heart diseasemay, by ECG analysis, be less common in headache cases than nonheadache controls.

Psychophysiological characteristics of headache patients

Migraine, muscle-contraction headache patients, and non-headache controls were physiologically assessed during self-selected ‘stressful’ and ‘relaxing’ imagery in headache and non-headache states. Musculoskeletal (frontalis, bilateral temporalis), vascular (heart rate, bilateral temporal artery pulse volume), and autonomic (skin conductance response) measures failed to differentiate the groups on resting response levels — in both headache and non-headache states. ‘Stressful’ imagery elicited greater reactivity than ‘relaxing’ imagery in all three response systems, regardless of headache type. However, a group by condition interaction eventuated only for the electromyographic measures, indicating that the muscle-contraction patients were significantly more reactive during stressful imagery than migrainers and controls.

Psychophysiological response patterns in vascular and muscle-contraction headaches

The psychophysiological response patterns of 43 headache subjects were compared to the response patterns of 11 nonheadache control subjects. The headache group was composed of subjects diagnosed as suffering from either muscle-contraction (N = 11), classic migraine (N = 11), common migraine (N = 11), or mixed (N = 10) headache. Discriminant analyses indicated that (1) the headache groups could be perfectly differentiated from the nonheadache control group after a period of relaxation and during a period of psychological stress and (2) the stress condition differentiated among the various headache groups. In general, the headache groups showed a higher level of arousal and were more responsive to stress. Also, the response pattern profiles differed among the headache groups in the stress condition. Muscle-contraction subjects tended to respond with higher frontal EMG, and classic migraine and mixed headache groups tended to respond with larger cardiovascular responses.

Psychophysiology of recurrent headache: Methodological issues and new empirical findings

Traditional accounts of headache attribute migraine to an unstable vasomotor system and tension to prolonged contraction of skeletal muscles. Investigations of the psychophysiology of headache testing these assumptions have produced conflicting results, however. Review of investigations conducted since 1970 reveals that certain methodological shortcomings may account, in part, for this confusion. Data are reported for a study which attempted to control these methodological deficiencies. Headache subjects, diagnosed as migraine, tension, or combined migraine and tension, were compared to nonheadache control participants who were matched on the basis of sex, income, marital status, age, and life events. All subjects were exposed to a variety of experimental conditions (rest, self-control, and stress) while physiological recordings were obtained for forehead and forearm EMG, temporal artery blood flow, hand surface temperature, heart rate, and skin resistance level. No main effects for groups were found for any measures, and group by condition interactions revealed no consistent pattern of results. The data do not support the traditional notions of headache.

Psychological functioning in headache sufferers.

The present study examined the psychological test responses of 99 headache sufferers and 30 matched nonheadache controls. Headache subjects were of four types: migraine (n = 26), muscle contraction (n = 39), combined migraine-muscle contract ion (n = 22), and cluster (n = 12). Measures consisted of the Minnesota Multiphasic Personality Inventory, a modified hostility scale derived from the MMPI, Back Depression Inventory, State-Trait Anxiety Inventory, Autonomic Perception Questionnaire, Rathus Assertiveness Schedule, Social Readjustment Rating Scale, Psychosomatic Symptom Checklist, Schalling-Sifneos Scale, Need for Achievement, and Hostile Press. Significant differences were found on five clinical scales of the MMPI--1, 2, 3, 6, and 7. Of the non-MMPI scales, only the Psychosomatic Symptom Checklist and Trait Anxiety Inventory were significant. Control subjects revealed no significant findings on any tests. The headache groups fell along a continuum, beginning with cluster subjects, who showed only minimal distress, continuing through migraine and combined migraine-muscle contraction, and ending with muscle contraction subjects, who revealed the greatest degree of psychological disturbance. However, none of the headache groups could be characterized by marked elevations on any of the psychological tests, which contrasts with past research findings. It is suggested that the present results may be more representative of the "typical" headache sufferer.

Stress and chronic headache: A psychophysiological analysis of mechanisms

This study investigated the effects of three types of laboratory stressors (stressful imagery, mental arithmetic, pain) on temporal artery, skeletal muscle, general autonomic [digital blood volume pulse (DBVP), spontaneous resistance responses (SRR's)] and self-report measures of distress in chronic migraine, mixed, muscle contraction and non-headache controls. All subjects were female, free of medication at time of testing and equated for age. Headache subjects reported a 19 year history of headache. Results revealed a pattern of digital BVP (constriction), SRR's (increase) and frontal EMG (increase) indicative of a general autonomic-skeletal arousal response to all three stressors in all groups, while the temporal artery response to the pain stimulus was vasodilation. Distress ratings were elevated during the stress periods for all four groups. Pain threshold and tolerance and the tendency to utilize cognitive coping strategies during exposure to pain did not differ across the four groups. The results do not support the general autonomic dysfunction theory of migraine or the specificity hypothesis implicating an overreactive temporal artery or skeletal muscle response to stress in migraine and muscle contraction headache, respectively. Despite epidemiological research supporting the stress-headache relationship, the present results indicate that the psychophysiological mechanism underlying this relationship does not appear to involve abnormal tonic levels or phasic response to stress. It is argued that the temporal artery dilation response to pain questions the role of stress in triggering the two stage vasoconstriction-dilation mechanism of migraine and suggests the need to evaluate a four stage model as a potential psychophysiological mechanism underlying the stress-headache relationship.

An experimental investigation of pain production in headache patients.

An experiment was conducted to test two assumptions underpinning the prevailing medical model of tension headache: (1) that tension headache pain is due to sustained contraction of the skeletal muscles of the scalp; (2) that the muscle contraction produces greater pain for tension headache patients than for migraineurs. Six tension headache patients and six migraine patients were compared with six matched non-headache control subjects. All subjects used visual EMG biofeedback to hold different levels of frontalis muscle contraction for periods of one and three minutes. Ratings of pain and subjective tension were obtained for all trials. The results provided little support for either hypothesis. Pain ratings were not clearly related to induced EMG levels, but there was clear evidence that subjective tension was a function of EMG activity. It is suggested that the role of psychological factors in the production of pain should be further explored.

Physiologic and self-report comparisons between tension headache sufferers and nonheadache controls

Tension headache sufferers and nonheadache controls were compared with respect to (1) frontal EMG during both baseline and presentation of an imagined stressor, (2) trait anxiety, (3) locus of control expectancies for health related behaviors, and (4) exposure to stressful life events. Tension headache sufferers displayed higher resting muscle tension levels than did nonheadache controls. However, both groups responded similarly to the imagined stress stimulus and displayed significant muscle tension elevations of similar magnitude. While tension headache sufferers reported higher levels of trait anxiety, no differences were found between the two groups for locus of control expectancies and exposure to stressful life events. The diagnostic and treatment implications of these findings are discussed.