Tension-type Headache Subjects Research Articles

Effects of Dry Needling on Active Myofascial Trigger Points and Pain Intensity in Tension-Type Headache: A Randomized Controlled Study.

Tension-type headache is the most prevalent type of headache and is commonly associated with myofascial pain syndrome and the presence of active myofascial trigger points. This randomized controlled trial aimed to assess the impact of dry needling on the total number of active trigger points, pain intensity, and perceived clinical change in tension-type headache subjects. Thirty-two subjects were randomly assigned to the control and dry needling groups. The presence of active trigger points in 15 head and neck muscles, the headache intensity, and the perceived clinical change were evaluated. A single dry needling technique was administered at each active trigger point across three sessions. Significant differences were observed in the post-treatment measures favouring the dry needling group, including reductions in the headache intensity scores (p = 0.034) and the total number of active trigger points (p = 0.039). Moreover, significant differences in the perception of clinical change were found between the control and treatment groups (p = 0.000). Dry needling demonstrated positive effects in reducing the number of active trigger points and improving the short-term headache intensity in tension-type headache patients. A single dry needling session applied in the cranio-cervical area resulted in a self-perceived improvement compared to the control subjects.

The prevalence and impact of tension-type headache in school-aged children in Iran.

Tension-Type Headache (TTH) is regarded as the third most prevalent disorder worldwide, prompting children to seek medical attention. Our objective is to investigate the prevalence of TTH among students aged 6 to 18 years in various geographical regions of Iran, while also assessing the impact of headaches on their quality of life. Employing a cross-sectional survey, we have carefully distributed self-completed structured questionnaires to students in 121 meticulously selected schools throughout the country, ensuring the representation of its diverse population. Among the 2,958 potential participants, we have included a total of 2031 individuals in our study. This comprises 57.3% children and 42.7% adolescents, with 50.02% being males and 49.97% females. Specifically, we have examined 950 subjects with TTH and 1,081 individuals without any form of headache. TTH was diagnosed in 32.1% of the participants. Notably, we have observed a significant difference in the average age between the TTH subjects and those without headaches. Participants without headaches were more likely to be enrolled in primary schools, while those diagnosed with TTH predominantly attended high schools. We found no significant relationship between urban-rural areas or different geographic regions and the prevalence of TTH or its subtypes. Phonophobia was commonly associated with TTHs. Lastly, the mean quality-of-life score was highest for individuals without headaches, followed by those with low frequency episodic TTH, high frequency episodic TTH, and chronic TTHs. There was also a significant relation between headache severity and quality of life scores. The significant prevalence of TTH in children and adolescents and its adverse impact on the daily activities of individuals underscore the utmost importance of accurate diagnosis and efficient management.

The Relationship between Infant Colic and Migraine as well as Tension-Type Headache: A Meta-Analysis.

Background Infant colic is a common benign disease during early infancy. Migraine and tension-type headache (TTH) are the most common primary headache forms among pediatric population. Several studies have investigated the incidence of infant colic in patients with migraine and TTH. The meta-analysis was to assess the relationship between infant colic and migraine as well as TTH. Methods PubMed, Web of Science, and Cochrane Library were searched until August 16, 2018, for potential studies. Data were extracted by two independent authors and analyzed using RevMan 5.2 software. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to determine the association between infant colic and migraine as well as TTH, respectively. Results A total of 148 studies were found, and 7 studies were finally included. A higher incidence of colic during infancy was revealed in migraine patients than controls (P=0.05, OR: 2.51, 95% CI: 1.32–4.77) and TTH subjects (P=0.02, OR: 0.33, 95% CI: 0.13–0.86), respectively. And no significances were found between TTHs with controls (P=0.51, OR: 1.17, 95% CI: 0.73–1.89). Conclusion This meta-analysis indicated that migraine was associated with increased incidence of infantile colic history, but TTH incidence was not relevant with the incidence of infantile colic history.

Sleep and Tension-Type Headache.

Tension-type headache (TTH) is a common neurological condition that is related to sleep dysfunction. This review discusses recent evidence for the association between TTH and sleep disturbances. There is an increasing evidence for the association of TTH with sleep disturbances including insomnia, poor sleep quality, excessive daytime sleepiness, insufficient sleep, and shift working. Most studies have reported that sleep disturbances are more prevalent among subjects with TTH than among subjects without headaches. Clinical presentations of TTH are more exacerbated in TTH subjects with sleep disturbances than in those without sleep disturbances. Further, the close association of TTH with sleep disturbances is more robust in subjects with chronic TTH than in those with episodic TTH. Growing evidence highlights the association of TTH with psychiatric comorbidity, which is closely associated with sleep disturbances. Recent advances in our understanding of the association between sleep and TTH will help in improved diagnosis and treatment of TTH and sleep disturbances.

Comorbidity of gastrointestinal disorders, migraine, and tension-type headache: a cross-sectional study in Iran

Migraine can be accompanied by some gastrointestinal (GI) disorders. In this study, we aimed to investigate the relationship between migraine and tension-type headache (TTH) and different lower and upper GI disorders as well as non-alcoholic fatty liver (NAFLD) and cholelithiasis. This cross-sectional study included 1574 overweight and obese participants who were referred to the Obesity Research Center of Sina Hospital, Tehran, Iran. The diagnosis of migraine and TTH was made by an expert neurologist based on the international classification of headache disorders-III β (ICHD III β). GI disorders, including irritable bowel syndrome (IBS), constipation, heartburn, dyspepsia, non-alcoholic fatty liver (NAFLD), and cholelithiasis, were diagnosed by a gastroenterology specialist. The overall mean age of participants was 37.44±12.62. A total of 181 (11.5%) migraine sufferers (with and without aura) and 78 (5%) TTH subjects were diagnosed. After adjusting for potential confounders by multivariable regression models, migraine had significant association with IBS (OR=5.16, 95% CI=2.07-12.85, P=0.000), constipation (OR=3.96, 95% CI=2.25-6.99, P=0.000), dyspepsia (OR=4.12, 95% CI=2.63-6.45, P=0.000), and heartburn (OR=5.03, 95% CI 2.45-10.33, P=0.000), while the association between migraine and NAFLD was marginally significant (OR=2.03, 95% CI=0.98-4.21, P=0.055). Furthermore, the prevalence of NAFLD (OR=2.93, 95% CI 1.29-6.65, P=0.010) and dyspepsia (OR=4.06, 95% CI=2.24-7.34, P=0.000) was significantly higher in TTH patients than the headache-free group. These findings show an association between GI disorders and primary headaches especially migraine and are, therefore, of value to the management of migraine and TTH. Further studies should investigate the etiology of the relationship between all subtypes of primary headaches and GI disorders.

Calcitonin Gene-Related Peptide as a Biomarker in Migraine

Background: Migraine is a prevalent disease with much economic burden and relatively inadequate available treatment. Calcitonin gene-related peptide (CGRP) is the most abundant neuropeptide in the trigeminal nerve and it may be involved in the pathogenesis of migraine. The aim of the study was to determine the plasma level of CGRP in patients with primary headache, and if it could be a potential biomarker for migraine. Methods: The study involved four groups with 20 patients in each one: chronic migraine, episodic migraine, cluster headache and tension type headache subjects, as well as healthy volunteers of matched age and sex as controls. Their venous blood was drawn, plasma was separated, and CGRP was analyzed with commercially available ELISA kit. Results: Plasma CGRP levels were significantly increased in chronic migraine (165.0 ± 17.9 ng/L, range 131.8 - 194.6) as compared with control group (70.5 ± 8.36 ng/L, range 51.7 - 83.65), patients with episodic migraine (94.1 ± 17.83 ng/L, range 69.6 - 121.9), and patients with cluster headache and tension type headache (87.2 ± 13.8 ng/L, range 62.8 - 110.8). Plasma CGRP levels in chronic migraine were significantly higher in patients with aura (191.32 ± 5.09, range 185.45 - 194.60) than without aura (160.30 ± 14.93, range 131.80 - 186.0), and in episodic migraine were significantly higher in patients with aura (109.88 ± 7.54, range 100.70 - 116.30) than without aura (90.16 ± 17.56, range 69.60 - 121.90). Conclusion: The plasma CGRP levels were elevated in patients with chronic migraine and may be considered a potential biomarker for it. This opens the door for a therapeutic role of it for migraine. J Neurol Res. 2017;7(6):103-107 doi: https://doi.org/10.14740/jnr460w

Association of the Apolipoprotein E polymorphism with migraine: a meta-analysis.

BackgroundApolipoprotein E (ApoE) gene has been reported to be associated with migraine and tension-type headache (TTH), but the results are conflicting. This study aimed to evaluate the association of ApoE with migraine by a meta-analysis.MethodsMEDLINE, ISI Web of Knowledge, The Cochrane Central Register of Controlled Trials, and EMBASE databases were searched to identify eligible studies published in English from 2000 to 2014. Data were extracted using standardized forms. The association was assessed by relative risk (RR) with 95 % confidence intervals (CIs) using a fixed or random effects model.ResultsFour studies, comprising 649 migraineurs, 229 TTH subjects and 975 controls, met all the criteria and were included in the meta-analysis. No significant difference was found comparing genotypic and allelic frequencies in the case of migraineurs versus controls and TTH subjects versus controls. Only when migraineurs and TTH subjects were considered as a whole group, ApoE4 was found to increase the relative risk of headache by 1.48 (95 % CI 1.16, 1.90; P = 0.002), compared to controls.ConclusionsApoE ε4 allele is not associated with migraine susceptibility, but is positively related to headache (including migraine and TTH).

Primary headaches and myofascial pain syndrome

Myofascial pain syndrome is a complex of sensory, motor and autonomic symptoms that are caused by myofascial trigger points. Compression of these trigger points can induce local and referred pain. This article reviews the available published knowledge about the relationship of primary headaches and myofascial pain syndrome. Headache patients have significantly more trigger points than those without headaches. There is no difference in trigger points` prevalence between migrainous and patients with tension-type headache patients. In patients with unilateral migraine, there are significantly more trigger points ipsilateral to migraine headaches. There are a positive and significant correlation between the presence of trigger points and headache frequency and duration in migranous and chronic tension-type headache subjects. Sensitization of pain pathways in the central nervous system due to prolonged nociceptive stimuli from myofascial trigger points may contribute to the conversion of episodic to chronic headache. Patients with migraine and/or tension-type headache who had myofascial trigger points that, when pressed, reproduce their typical headache pain may be treated with trigger point injections.

Field testing the alternative criteria for tension-type headache proposed in the third beta edition of the international classification of headache disorders: results from the Korean headache-sleep study.

BackgroundAccording to the third beta edition of the International Classification of Headache Disorder (ICHD-3 beta), the diagnostic criteria for tension-type headache (TTH) might lead to the inclusion of individuals with headaches showing migrainous features. To better define TTH, the alternative diagnostic criteria were proposed in the appendix of ICHD-3 beta. This study attempted to test the alternative criteria for diagnosis of TTH proposed in ICHD-3 beta in a population-based sample from Korea.MethodsWe selected participants from the Korean population aged 19–69 years using stratified random sampling and evaluated them by interview using a questionnaire designed to identify headache type, headache characteristics, and psychiatric comorbidities.ResultsOf the 2,762 participants, 586 (21.3%) were diagnosed as having TTH using the standard criteria. Among these, 238 (40.6%) were also classified as having TTH using the alternative criteria. All 238 TTH subjects first diagnosed as having TTH by the alternative criteria were also classified as having TTH by the standard criteria. If the standard criteria were not applied, the remaining 348 patients were subclassified as having probable migraine (115, 19.6%) and unclassified headache (233, 39.7%). Compared with subjects diagnosed with TTH using the standard criteria, those diagnosed using the alternative criteria were less likely to demonstrate unilateral, pulsating headache, which is aggravated by movement, photophobia, phonophobia, and osmophobia.ConclusionUsing the alternative criteria, less than half of the subjects with TTH according to the standard criteria were classified as having TTH. All the subjects with TTH by the alternative criteria were classified as having TTH by the standard criteria. This study also demonstrated that subjects diagnosed with TTH using the standard criteria could include people with headaches showing migrainous features.

Comparison of clinical characteristics of migraine and tension type headache.

Context:Migraine and tension type headache (TTH) are two most common types of primary headaches. Though the International Classification of Headache Disorders-2 (ICHD-2) describes the diagnostic criteria, even then in clinical practice, patients may not respect these boundaries resulting in the difficulty in diagnosis of these pains.Materials and Methods:This cross-sectional study involved 50 subjects in each of the two groups – migraine and TTH – after screening for the inclusion and exclusion criteria. Diagnosis was made according to the ICHD-2 criteria. Their clinical history was taken in detail and noted in a semi-structured performa. They were examined for the presence of a number of factors like pericranial tenderness and muscle parafunction. Statistical analysis was done with the help of SPSS v 11.0. To compare the non-parametric issues, chi-square test was run and continuous variables were analyzed using independent sample t test.Results:In general, migraineurs had progressive illness (χ2=9.45; P=0.002) with increasing severity (χ2=21.86; P<0.001), frequency (χ2=8.5; P=0.04) and duration of each headache episode (χ2=4.45; P=0.03) as compared to TTH subjects. Along with the headache, they more commonly suffered orthostatic pre-syncope (χ2=19.94; P<0.001), palpitations (42%vs.18% among TTH patients; χ2=6.87; P=0.009), nausea and vomiting (68% vs. 6% in TTH; χ2=41.22; P<0.001, and 38% vs. none in TTH; χ2=23.45, P<0.001, respectively), phonophobia (χ2=44.98; P<0.001), photophobia (χ2=46.53; P<0.001), and osmophobia (χ2=15.94; P<0.001). Their pain tended to be aggravated by head bending (χ2=50.17; P<0.001) and exercise (χ2=11.41; P<0.001). Analgesics were more likely to relieve pain in migraineurs (χ2=21.16; P<0.001). In addition, post-headache lethargy was more frequent among the migraineurs (χ2=22.01; P<0.001). On the other hand, stressful situations used to trigger TTH (χ2=9.33; P=0.002) and muscle parafunction was more common in TTH patients (46% vs. 20%; χ2=7.64; P=0.006). All the cranial autonomic symptoms were more common in migraineurs as compared to TTH subjects (conjunctival injection: χ2=10.74, P=0.001; lacrimation: χ2=17.82, P<0.001; periorbital swelling: χ2=23.45, P<0.001; and nasal symptoms: χ2=6.38, P=0.01).Conclusion:A number of symptoms that are presently not included in the ICHD-2 classification may help in differe-ntiating the migraine from the TTH.

Plasma calcitonin gene-related peptide concentration is comparable to control group among migraineurs and tension-type headache subjects during interictal period: response to comments by Tfelt-Hansen and Ashina

We thank Drs. Tfelt-Hansen and Ashina [1] for their interest in our article [2]. They have raised a valid point, namely that measurement units should be similar in the scientific literature. We assume that different units mentioned in previous studies were provided by the respective manufacturer of the kit, and we followed the same custom. However, in the interest of uniformity in the literature, as indicated by Drs. Tfelt-Hansen and Ashina, we provide revised results here (Table 1). A concern was raised regarding the higher inter-ictal concentration of plasma CGRP in the cubital blood than reported in previous studies [3–7]. The available literature provides conflicting results regarding plasma CGRP concentration in migraineurs, both ictal as well as inter-ictal, and even when the blood was collected from different areas (external jugular/internal jugular and cubital) [2–9]. Hence, no conclusion can be reached regarding the baseline concentration of CGRP in plasma. The higher concentration reported in the present study than in previous studies can be explained by a number of methodological factors. First, the CGRP has a very short half life, barely 7 min, hence we made sure that plasma samples were frozen to -70 C within 5 min of drawing the blood [10, 11]. In a number of studies the sample was centrifuged for 15 min [6, 8, 12]. This could have resulted in lower levels. Secondly, it must be remembered that peptides are unstable molecules and they need to be preserved at -70 C. At least in one study samples were stored at –20 C until analysis, and this could have affected the results [13]. Moreover, the plasma level of CGRP follows a circadian pattern and shows troughs and peaks, but at different times according to different studies [14, 15]. We had drawn blood samples between 9 a.m. and 12 noon, when CGRP concentration is highest [14]. Furthermore, sampling methods and anticoagulants may affect the quantitative analysis with some peptides [16]. These factors could have affected the results of previous studies as they used different anticoagulants, e.g. heparin or aprotinin [6, 8, 13]. We used EDTA tubes to collect the blood on the manufacturer’s recommendation. Lastly, the measurement of CGRP is influenced by a number of factors present in the plasma that may cross-react with it (Peninsula Lab Inc., LLC), hence we used the extraction-free kit. This further reduces the chances of error. The sensitivity of the ELISA kit used in this study was 21 pmol/l and the range was 0–6596 pmol/l (Peninsula Lab Inc., LLC) with intra-assay variation of less than 5%. Thus, the results of these kinds of studies warrant further studies in this area with better methodologies, until conclusive evidence is yielded. R. Gupta (&) Sleep and Headache Care, 1061 Kissan Marg, Barkat Nagar, Rajasthan, Jaipur 302015, India e-mail: guptaravi_2003@yahoo.co.in

Plasma calcitonin gene-related peptide concentration is comparable to control group among migraineurs and tension type headache subjects during inter-ictal period

Calcitonin gene-related peptide (CGRP) is known to increase during acute attack of migraine and tension type headache (TTH). However, its concentration during inter-ictal period is not known. This may help us to understand the pathophysiology of these headaches. The objectives of this study are to find out the concentration of CGRP in plasma during inter-ictal period among migraineurs and TTH and to compare it with control group through cross-sectional study from headache clinic of a tertiary centre. Study sample comprised of three groups: migraineurs, TTH subjects as well as a healthy control group. Fifty subjects in each group were included after screening for the respective inclusion criteria and exclusion criteria. None of the subjects was blood relatives of other subject. Their venous blood was drawn and plasma was separated to be kept at −70°C. CGRP was analysed with commercially available ELISA kit. Data were analysed with the help of SPSS V 11.0 for Windows. Chi-square, independent sample t test and one-way ANOVA with post hoc Tukey and univariate regression were performed. Plasma CGRP concentration was not different among three diagnostic groups (F = 0.78; P = 0.49). Similarly, plasma CGRP concentration was not different among episodic TTH and chronic TTH groups (t = 0.32; P = 0.97) and comparison of episodic and chronic migraine groups also revealed similar results in this study (1.14 vs. 0.94 ng/ml; P = 0.23). The presence of aura did not affect the inter-ictal CGRP levels among migraineurs (F = 0.16; P = 0.85). In conclusion, this study suggests that migraine and TTH could be episodic disorders and subjects have comparable CGRP levels during inter-ictal period.

Polymorphism in apolipoprotein E among migraineurs and tension-type headache subjects

Nitric oxide plays an important role in the pathogenesis of migraine as well as tension-type headache. Studies suggest that the expression of molecules involved in the pathogenesis of headache, i.e., nitric oxide and interleukin, is influenced by apolipoprotein E (APOE) and is gene specific. Hence, we hypothesized that APOE polymorphism may be associated with migraine as well as tension-type headache.The study sample comprised of three groups: migraineurs, tension-type headache subjects as well as a healthy control group. A total of 50 subjects in each group were included after screening for the inclusion and exclusion criteria. None of the subjects was a blood relative of any other subject included in the present study. Their venous blood was drawn and stored at −20°C. Genomic DNA extraction was performed with a commercial kit and simple sequence-specific primer PCR was performed to assess the APOE polymorphism. Data were analyzed with the help of SPSS V11.0 for Windows. χ2 test and logistic regression analysis were run. The results of the study showed that APOE ε2 gene increases the risk of migraine as compared to the control group and the tension-type headache group (OR = 4.85; 95% CI = 1.92–12.72; P < 0.001 and OR = 2.31; 95% CI = 1.08–4.94; P = 0.01, respectively). Interestingly, APOE ε4 gene was protective against migraine as well as tension-type headache. This study shows that APOE ε2 gene increases the risk of migraine, while APOE ε4 gene is protective against migraine and tension-type headache. Further research is required to confirm the findings of the present study in a larger sample and to elucidate the role of APOE polymorphism in headache.

Comparison of oxidative stress among migraineurs, tension-type headache subjects, and a control group.

Background:A primary headache, particularly migraine, is associated with oxidative stress during the attack. However, data regarding the interictal state in migraineurs and in those with tension-type headache (TTH) is limited.Objectives:(1) To assess the oxidative stress in migraineurs and TTH subjects in between the episodes and (2) to see if there is a difference in the degree of oxidative stress in the different subtypes of migraine and TTH.Materials and Methods:Fifty migraineurs, 50 patients with TTH, and 50 control subjects were included in this study after screening for the exclusion criteria. Diagnosis of headache was made according to the International Classification of Headache Disorders (ICHD)-2 criteria. A venous blood sample was collected from the antecubital vein at least 3 days after the last attack of headache. The sample was centrifuged immediately and the plasma was stored at –70°C. The ferric reducing activity of plasma (FRAP) and the malondialdehyde (MDA) levels were assessed using colorimetric methods. Statistical analysis was done with the help of SPSS for Windows, v 11.0. One way ANOVA with post hoc Tukey test, independent sample t test, univariate regression, and multivariate regression analysis were done as indicated.Results:Migraineurs had higher values of MDA and FRAP than the subjects in the other two groups (P<0.001). No difference was observed between the TTH group and the control group. FRAP levels were significantly higher in subjects who had mixed migraine (migraine with aura and without aura) as compared to those with only migraine without aura (mean difference 196.1; 95% CI = 27.3 to 364.9; P = 0.01). Similarly, oxidative stress was significantly higher in patients with episodic TTH as compared to those with chronic TTH (FRAP t = 3.16; P = 0.003 and MDA t = 2.75; P = 0.008).Conclusions:This study suggests that oxidative stress continues even between headache episodes in migraineurs but not in those with TTH. This could probably be consequent to the different pathophysiological mechanisms of TTH and migraine.

Subclinical deviation of the subjective visual vertical in patients affected by a primary headache

Conclusion. Our results suggest that patients with migraine or tension-type headache have subclinical deviations of the subjective visual vertical, which may be associated with their subjective imbalance Objectives. Patients affected by migraine or tension-type headache often complain of unsteadiness. However, they rarely show a clinical significance in the objective examinations of their equilibrium. We investigated the equilibrium functions in patients affected by migraine or tension-type headache Subjects and methods. We investigated the neurotological findings of 17 patients with migraine, 20 patients with tension-type headaches, and 16 patients without headache. All patients in this study experienced vertigo or dizziness before they underwent the examination; however, they never had vertigo attacks for more than 1 month before the examination. All patients in this study were tested during headache-free intervals Results. There was no significant difference in the hearing levels of pure tone audiometry, the canal palsy percentage of bithermal caloric test, and the body sway in posturography among the three groups (p>0.05, Mann-Whitney U test). The average values in absolute deviations of subjective visual vertical (SVV) in patients with tension-type headache (1.3±1.1°) and patients with migraine (1.5±1.2°) were significantly larger in comparison with those of patients without headache (0.6±0.4) (p<0.05, Mann-Whitney U test). Intra-individual varaiances of the SVV in patients with primary headache were significantly larger than those in patients without headache (p<0.05, Mann-Whitney U test).

Increased Plasma Matrix Metalloproteinase‐9 Levels in Migraineurs

Cortical spreading depression and neurogenic inflammation have been hypothesized to be key steps in the development of migraine headache. Recent studies have highlighted matrix metalloproteinase-9 (MMP-9) in cortical spreading depression, neurogenic inflammation, and cerebral ischemia. To seek their possible association, we investigated plasma MMP-9 levels in migraineurs during headache-free periods. Plasma MMP-9 levels in 84 migraine subjects and 61 controls were determined by enzyme-linked immunosorbent assay. In addition, 23 patients with tension type headache were included in the study as comparative subjects. The MMP-9 levels in migraineurs (42.5+/-4.6 ng/mL, mean+/-SE) were significantly higher than those in controls (25.4+/-2.7 ng/mL, P< .005). Those levels in tension type headache subjects (24.6+/-4.8 ng/mL) did not differ from those in controls. There was no significant difference between subjects having migraine with aura and those without aura. The MMP-9 levels did not correlate with age, duration of illness, frequency of migraine attack, duration of headache attack, or medication for headache. Mean plasma MMP-9 levels were the highest in subjects from whom blood samples were taken 2-4 days after their latest attack. The degradation of extracellular matrix showing the increase of MMP-9 in migraineurs may be associated with an abnormality in their blood vessel permeability. MPP-9 plays some role in migraine pathophysiology. Further studies of MMPs are necessary to elucidate their role.

Psychological and emotional aspects and pain.

A patient's psychological condition can be influenced by symptoms and, at the same time, it can influence the perception of symptoms. In psychological assessment, pain can modify the results of a questionnaire, so a patient's state at the moment of the evaluation should be taken into account. Questionnaires used in assessment do not always provide clear-cut answers concerning the individual psychological component. Moreover, difficulties in classifying headache patients does not permit correct comparisons between population samples whenever patients are not classified into well defined homogeneous groups. Overall, in the three groups examined - migraine, tension-type headache and cluster headache - it can be affirmed that with self-report assessment based on questionnaires, the tension-type headache subjects present a more interesting psychological profile for its clinical implications.

Cross-correlation between stress, pain, physical activity, and temporalis muscle EMG in tension-type headache.

Thirty-six tension-type headache subjects and 36 non-headache matched controls recorded their temporalis muscle electromyographic (EMG) activity and their pain intensity, stress and physical activity levels in a daily diary. Measurements were performed every 30 min for 6 days (EMG 3 days only). A time-lagged cross-correlational analysis between pain, stress, physical activity, and EMG shows that the highest correlation coefficient values occurred between pain and stress at the same (r = 0.33) and at the two preceding 0.5 h time points (r = 0.21 and r = 0.26) in the headache group. Virtually no correlation was found between pain, stress, or physical activity with EMG for either group. These data show that temporalis muscle activity levels were not related to the rise and fall of the subjects' pain or stress levels. Conversely, elevated stress appeared to be highly related to pain; it occurs as both an antecedent and simultaneous event with elevated headache pain.