Muscle discrimination ability at three muscle sites in three headache groups

The present study examined the ability of three headache groups (migraine, mixed migraine/tension, and tension) to accurately discriminate subjective levels of muscle tension at the forearm flexor, frontalis, and trapezius muscle sites. Discrimination ability was assessed at pre- and posttreatment using a psychophysical method of magnitude production. Results show that the ability to discriminate muscle tension levels at pretreatment varied across the headache groups, with migraineurs being the most accurate (r = .854), followed by the mixed headache group (r = .785), and finally the tension headache group (r = .732). Discrimination ability significantly increased at the posttreatment assessment. A multiple regression analysis showed that pretreatment performance on the muscle discrimination task significantly predicted outcome (r = .75) from relaxation and biofeedback training for migraine patients but not for the mixed or tension headache groups.     

Muscle discrimination ability at three muscle sites in three headache groups

The present study examined the ability of three headache groups (migraine, mixed migraine/tension, and tension) to accurately discriminate subjective levels of muscle tension at the forearm flexor, frontalis, and trapezius muscle sites. Discrimination ability was assessed at pre- and posttreatment using a psychophysical method of magnitude production. Results show that the ability to discriminate muscle tension levels at pretreatment varied across the headache groups, with migraineurs being the most accurate (r=.854), followed by the mixed headache group (r=.785), and finally the tension headache group (r=.732). Discrimination ability significantly increased at the posttreatment assessment. A multiple regression analysis showed that pretreatment performance on the muscle discrimination task significantly predicted outcome (r=.75) from relaxation and biofeedback training for migraine patients but not for the mixed or tension headache groups.This research was supported by a grant from NINCDS, NS-15235.     

EMG levels in the occipitofrontalis muscles under an experimental stress condition

In view of the importance attached to the frontalis muscles by researchers into the etiology of head pain and its treatment by biofeedback techniques, it is surprising that no data have yet been reported on the functioning of the occipitalis muscles, which have a close physiological relationship to the frontales. This study explores the response of the frontalis and occipitalis muscles under a condition of experimental stress. Migraine and tension-headache sufferers were separately compared with a headache-free control group under four conditions: baseline, while listening to instructions, while carrying out an auditory vigilance task, and for a further resting period equivalent to baseline. Results showed that tension levels in the frontalis muscles were not elevated at rest in any of the experimental groups, nor were they significantly responsive to the experimental task. The occipitales however proved to have significantly higher levels in both the tension-headache and migraine groups during the task and recovery periods. The results for the tension group reached significance because of a drop in control group values. These results may have significance in determining the best site for electrode placement in biofeedback.Thanks are due to Professor John Darroch for statistical advice.     

Biofeedback applications to migraine and tension headaches: A double-blinded outcome study

The efficacy of progressive relaxation, fingertip temperature training, and EMG training of the frontalis muscles was tested against chronic migraine and tension headaches in a double-blinded 3×2 design. All 56 subjects reported being conditioned in the course of the nine 1/2-hour training sessions. Detailed records of perceived severity and duration of the headaches were maintained by the subjects before the study and for at least 3 months after the training period. While even a conservativeF revealed a diminution of perceived severity, of hours/month of headache, and of an index conceived by Budzynski, Stoyva, Adler, and Mullaney (1973), across time, at beyond the .05 level of significance, no specific treatment emerged as clearly most effective for either type of headache. Over time, however, progressive relaxation was not as good as the other procedures in reducing the number of hours/month of headache.     

Cephalic vasomotor feedback in the modification of migraine headache

The effect of cephalic vasomotor response (CVMR) and frontalis electromyographic (EMG) feedback on control of temporal arterial vasoconstriction and frontalis muscle activity in migraine and muscle contraction headache patients was investigated. A single subject multiple baseline design (across subjects and responses) was introduced to evaluate (1) patterning in the two physiological systems and (2) the effects of CVMR and EMG feedback on headache activity. The data indicated that (a) all four patients demonstrated an ability to control CVMR activity during CVMR feedback and EMG during EMG feedback, (b) idiosyncratic patterns of physiological activity emerge during feedback training, and (c) learned control of the pain mechanism for muscle contraction and migraine headaches was related to reduced frequency and duration of these headaches.Portions of this paper were presented at the Ninth Annual Convention of the Association for Advancement of Behavior Therapy, San Francisco, 1975.     

Multimodal biofeedback in the treatment of migraine

The purpose of this study was twofold: (a) to compare the effects of three behavioral strategies for the relief of migraine, and (b) to examine different combinations of the treatments to assess the effectiveness of multimodal biofeedback with this problem. Twenty-four volunteer migraine sufferers not on medication, and with at least weekly occurrence of headaches, participated in the study. Results indicated that (a) subjects who learned temporal cooling, frontalis relaxation, and progressive muscular relaxation exhibited the best success with headache relief; (b) control subjects, who did not show the same psychophysiological changes as experimental subjects, reported no headache relief; and (c) subjects in the group with only relaxation exercises performed similarly to control subjects and reported no headache relief.     

The relationship between muscle discrimination ability and response to relaxation training in three kinds of headaches

Accurate discrimination of changes in physiological response has been noted as an important element in learning to control that response. Using a magnitude production procedure involving forearm isometric contractions, it was found that the ability to discriminate muscle tension varied across headache groups, with the no-headache control group (r=.76) being most accurate, followed by the tension group (r=.68), the mixed tension and migraine group (r=.60), and finally the migraine group (r=.51). The most important result, however, was that muscle discrimination ability significantly predicted clinical outcome from treatment by relaxation training for tension headache subjects (r=.50) but did not predict outcome for migraine or mixed headache subjects.This research was supported by a grant from NINCDS, NS-15235.     

Precipitating and relieving factors of migraine versus tension type headache

ABSTRACT: BACKGROUND: To determine the differences of precipitating and relieving factors between migraine and tension type headache METHODS: This is a cross sectional study. We retrospectively reviewed the records of 250 migraine patients and 250 patients diagnosed as tension type headache from the specialized headache clinic in Dept. of Neurology, Dhaka Medical College Hospital. Data were collected through a predesigned questionnaire containing information on age, sex, social status and a predetermined list of precipitating and relieving factors. RESULTS: In this study, the female patients predominated (67%). Most of the patients were within 21--30 years age group (58.6%). About 58% of them belonged to middle class families. The common precipitating factors like stress, anxiety, activity, journey, reading, cold and warm were well distributed among both the migraine and tension type headache (TTH) patients. But significant difference was demonstrated for fatigue (p < 0.05), sleep deprivation (p < 0.05), sunlight (p < 0.01) and food (p < 0.05), which were common among migraineurs. In consideration of relieving factors of pain, different maneuvers were commonly tried by migraineurs and significant difference were observed for both analgesic drug and massage (p < 0.05), which relieved migraine headache. But maneuvers like sleep, rest and posture were used by both groups. CONCLUSION: The most frequent precipitating factors for headache appear to be identical for both migraine and TTH patients. Even though some factors like fatigue, sleep deprivation, sunlight and food significantly precipitate migraine and drug, massage are effective maneuver for relieving pain among migrianeurs.     

Weekly headache periodicity and the effect of weather changes on headache

A weekly periodicity in the occurrence of headache was found in 53 patients with migraine and in 20 with tension headache during an observation period of four weeks. In the migraine group the frequency was highest on Thursday and on Saturday and lowest on Sunday–Monday, and in patients with tension headache it was lowest on Sunday–Tuesday and highest on Friday. During the observation period several climatic factors were recorded. After correction for the weekly periodicity a highly significant correlation was found in the migraine group between headache frequency, on the one hand, and atmospheric pressure and outdoor temperature recorded 1–3 days later, on the other.     

HEADACHE—Pharmacological Approach to Treatment

The great majority of headaches a physician treats in office practice can be divided into two main categories, muscular contraction headache of tension type and vascular headaches of the migraine type.The most satisfactory symptomatic therapy for tension headache is by the use of a nonnarcotic analgesic agent combined with a tranquilizer or sedative. On the other hand, symptomatic relief of migraine is best obtained by the use of a suppository of ergotamine tartrate and caffeine combined with an antiemetic or antispasmodic.Interval treatment of patients with tension and migraine headache centers on helping the patient understand his emotional problems. Prophylactic drug therapy for patients with tension headache includes the limited use of tranquilizers and sedatives. Recently, striking benefits in some patients with migraine have been achieved by the prophylactic use of the antiserotonin drug methysergide (UML 491).     

Deficient Discrimination of EMG Levels and Overestimation of Perceived Tension in Chronic Pain Patients

Twenty chronic low back pain patients (CBP), twenty tension headache (THA) patients, and twenty healthy controls (HC) participated in a tension production task where subjects had to attain four levels (4, 8, 12, 16 V) of muscle tension at the m. frontalis and the m. erector spinae. Ratings of perceived tension, pain, and aversiveness as well as EMG, heart rate, and skin conductance levels were recorded. Signal detection and correlational methods revealed that the patients were deficient in muscle tension discrimination at high tension levels in both muscles. They generally overestimated low and underestimated high levels of muscle tension, especially in the CBP group. At low muscle tension levels, both healthy controls and patients showed deficient discrimination ability. Perceived muscle tension, aversiveness, and pain ratings during the tasks were higher in the patient groups. These data confirm and clarify previous reports of deficient tension perception and show concurrent overestimation of bodily symptoms in chronic musculoskeletal pain patients.     

Cerebrospinal fluid gamma aminobutyric acid levels in migraine.

Gamma-Aminobutyric acid (GABA) levels in cerebrospinal fluid were measured in seven patients with tension headache and 12 patients with migraine. GABA was detected only during the migraine attack. The results suggest disordered GABA metabolism in migraine.     

What is an adequate length of baseline in research and clinical practice with chronic headache?

We examined the representativeness of baseline headache diary recording periods of 1, 2, 3, and 4 weeks for three kinds of headache disorder — tension, migraine, and combined migraine and tension. For research purposes at pretreatment, 2 weeks of diary recording are preferable for tension headache, while at least 3 weeks are preferred for migraine and combined headache. At follow-up, 1 week of diary recording appears adequate for all three headache types. Recommendations are also made for clinical practice.This research was supported by grants from NINCDS, NS-23440, and NIMH, MH-41341.     

心脏右向左分流对偏头痛患者临床症状的影响

目的:探讨心脏右向左分流(RLS)对偏头痛患者临床特征是否存在影响,并研究RLS分级与头痛强度之间的关系。方法:选择2016年6月-2018年12月青岛大学附属医院收治的偏头痛患者216例作为偏头痛组,选择于青岛大学附属医院体检的健康志愿者60例作为对照组。216例偏头痛患者根据有无RLS分为有RLS偏头痛组(127例)和无RLS偏头痛组(89例)。有RLS偏头痛患者根据RLS分级将其分为大分流组(n=51)、中分流组(n=11)和小分流组(n=65)。观察对照组与偏头痛组RLS情况,比较有RLS偏头痛组和无RLS偏头痛组患者的一般资料情况,比较大分流组、中分流组和小分流组患者的一般资料情况,采用多因素Logistic回归分析偏头痛患者产生RLS的危险因素。结果:对照组与偏头痛组小分流、中分流患病率比较差异无统计学意义(P0.05),而偏头痛组大分流患病率高于对照组(P0.05)。有RLS偏头痛组患者的视觉先兆、感觉先兆的比例均大于无RLS偏头痛组,头痛初始年龄均小于无RLS偏头痛组,头痛强度均高于无RLS偏头痛组(P0.05),两组患者年龄、性别、吸烟、饮酒、高血压、糖尿病、高血脂、运动先兆、遗传、头痛频率、头痛持续时间比较差异无统计学意义(P0.05)。不同RLS分级的偏头痛患者的视觉先兆、感觉先兆、头痛初始年龄、头痛强度整体比较差异有统计学意义(P0.05)。多因素Logistic回归分析显示,视觉先兆、感觉先兆、头痛初始年龄是偏头痛患者产生RLS的独立危险因素(P0.05)。结论:偏头痛发病年龄较小或有视觉先兆、感觉先兆可能提示偏头痛患者伴有RLS,RLS分级与头痛强度没有关系。     

Cognitive skills training versus EMG biofeedback in the treatment of tension headaches

In an effort to study the role of cognitive skills training in the treatment of psychosomatic disorders, two single-case design experiments were conducted to assess the relative effectiveness of biofeedback procedures and cognitive coping techniques in the alleviation of tension headaches. For both subjects, biofeedback training influenced mean frontalis EMG levels, although such changes were not associated with concomitant reductions in headache activity. It was the presence or absence of cognitive skills training, however, that determined whether each subject reported changes in headache levels. These results suggest that a more efficient treatment approach for tension headaches would involve an increased emphasis on the modification of maladaptive cognitive activity. The present findings support the general view that a comprehensive approach in the treatment of stress-related disorders requires a concomitant focus on the cognitive, behavioral, and affective dimensions of the symptom. It was also suggested that biofeedback technology may be a useful tool for studying the physiological consequences of particular cognitive processes and in identifying particular cognitions with anxiety-provoking properties.     

What is an adequate length of baseline in research and clinical practice with chronic headache?

We examined the representatives of baseline headache diary recording periods of 1, 2, 3, and 4 weeks for three kinds of headache disorder--tension, migraine, and combined migraine and tension. For research purposes at pretreatment, 2 weeks of diary recording are preferable for tension headache, while at least 3 weeks are preferred for migraine and combined headache. At follow-up, 1 week of diary recording appears adequate for all three headache types. Recommendations are also made for clinical practice.     

Self-regulatory treatment of headache in the elderly

We examined the utility of various combinations of relaxation, cognitive coping, and feedback in an uncontrolled series of 16 older headache patients (aged 60 to 77) diagnosed as having tension, mixed, or migraine headache. At 1-month follow-up, statistically and clinically significant reductions were observed in both overall headache activity and medication intake; 10 patients (63%) were more than 50% improved in both headache reduction and medication reduction. Female headache suffers were more improved than males. These results are inconsistent with our past findings with geriatric headache sufferers but consistent with other, more recent favorable findings. The efficacy of nondrug treatment for geriatric headache clearly warrants further attention.This research was supported in part by a grant from NINDS, NS-23440.     

Hand temperature norms for headache, hypertension, and irritable bowel syndrome

Hand temperature norms are presented for 221 headache patients (migraine, mixed, and tension), 105 hypertensives, 45 irritable bowel syndrome patients, and 56 normal controls under conditions of resting baseline, self-relaxation, volitional handwarming, mental arithmetic, and cold pressor. The two vascular headache groups (migraine and mixed) had significantly lower hand temperatures across conditions.     

Hand temperature norms for headache,hypertension, and irritable bowel syndrome

Hand temperature norms are presented for 221 headache patients (migraine, mixed, and tension), 105 hypertensives, 45 irritable bowel syndrome patients, and 56 normal controls under conditions of resting baseline, self-relaxation, volitional handwarming, mental arithmetic, and cold pressor. The two vascular headache groups (migraine and mixed) had significantly lower hand temperatures across conditions.This research was supported in part by grants from NINCDS (NS-15235 and NS-23440), from NHLBI (HL-27622 and HL-31189), and from NIDDK (DK-38614).