The second exteroceptive suppression of masseter muscle activity (ES2) and tenderness in pericranial muscles were evaluated in 112 young adults who met IHS criteria in the following diagnostic classifications: 31 chronic tension headache, 31 episodic tension headache, 33 migraine without aura and 17 migraine with aura. An additional 31 subjects served as controls. Pericranial muscle tenderness better distinguished diagnostic subgroups and better distinguished recurrent headache sufferers from controls than did masseter ES2. Chronic tension headache sufferers exhibited the highest pericranial muscle tenderness, and controls exhibited the lowest tenderness (P < 0.01). All chronic tension headache sufferers exhibited muscle tenderness in at least one of the pericranial muscles evaluated, while tenderness was exhibited by 52% of controls. The association between pericranial muscle tenderness and chronic tension headache was independent of the intensity, frequency, or chronicity of headaches. Our findings raise the possibility that pericranial muscle tenderness is present early in the development of tension headache, while ES2 suppression only emerges later in the evolution of the disorder.
Objective.—The present study examined the relationship between the diagnosis of migraine and self‐reported sexual desire. Background.—There is evidence for a complex relationship between sexual activity and headache, particularly migraine. The current headache diagnostic criteria even distinguish between several types of primary headaches associated with sexual activity. Methods.—Members of the community or students at the Illinois Institute of Technology (N = 68) were administered the Brief Headache Diagnostic Interview and the Sexual Desire Inventory (SDI). Based on the revised diagnostic criteria established by the International Headache Society (ICHD‐II), participants were placed in 1 of the 2 headache diagnostic groups: migraine (n = 23) or tension‐type (n = 36). Results.—Migraine subjects reported higher SDI scores, and rated their own perceived level of desire higher than those suffering from tension‐type headache. The presence of the symptom “headache aggravated by routine physical activity” significantly predicted an elevated SDI score. Conclusions.—Migraine headaches and sexual desire both appear to be at least partially modulated by serotonin (5‐HT). The metabolism of 5‐HT has been shown to covary with the onset of a migraine attack, and migraineurs appear to have chronically low systemic 5‐HT. As sexual desire also has been linked to serotonin levels, the results are consistent with the hypothesis that migraine and sexual desire both may be modulated by similar serotonergic phenomena.
This paper describes the development, construct and discriminant validity, and incremental utility of a headache self-efficacy scale. The Headache Self-Efficacy Scale is a 51 item scale designed specifically for recurrent headache sufferers. It assesses individuals' belief that they are able to do the things necessary to prevent a moderately painful headache when confronted with personally relevant headache precipitants. High self-efficacy was associated with less depression, anxiety, and physical symptoms, and less use of passive coping strategies (P < .01), even when headache frequency, intensity and chronicity were controlled statistically. Self-efficacy also explained unique variance in psychological and somatic symptoms beyond that explained by locus of control and general self-efficacy. These findings suggest that adaptation to headaches is influenced by self-efficacy beliefs, and that the assessment of self-efficacy may provide useful information in the evaluation of recurrent headache sufferers.
The validity of the International Headache Society (IHS) classification system for college‐aged students with headache was examined using cluster analysis. Undergraduate college student volunteers (N=369) underwent a structured diagnostic interview for headaches, and the sample was divided into two subsamples for purposes of replication. A hierarchical cluster analysis (Ward's method) of the headache characteristics reported by the first subsample suggested a statistically distinct three‐cluster solution, and the solution was replicated using the second subsample. It appeared that one cluster was tensionlike, while the other two were migrainelike. Nonhierarchical cluster analyses (K‐means) of the cases from each subsample revealed a similar pattern of a tensionlike and two migrainelike clusters. Identical three‐cluster solutions were found for the second subsample both by using cluster centers from the first subsample and by clustering the cases independently, suggesting that the cluster solution was not a random finding. The IHS classification system appears to lack adequate specificity and sensitivity for college‐aged students with headache who report migrainelike symptoms. Thus, the generalizability of research results using college‐aged students with headache to the adult population may be questionable.
Cluster analysis was used to validate headache diagnostic criteria of the International Headache Society (IHS). Structured diagnostic interviews were conducted on 443 headache sufferers from a community sample, which was randomly split to allow replication. Hierarchical cluster analysis of symptoms in both subsamples revealed two distinct ( P <.001) clusters: (1) unilateral pulsating pain, pain aggravated by activity, and photophobia and phonophobia, and (2) bilateral pressing/tightening pain, mild to moderate intensity, and absence of nausea/vomiting. These clusters were consistent with IHS migraine and tension‐type classifications, respectively. Replication using a non‐hierarchical clustering technique, k‐means cluster analysis, revealed a migrainelike patient cluster, reflecting more frequent pulsating, unilateral pain; more severe pain; and pain aggravated by activity; nausea, vomiting, photophobia, and phonophobia. A tensionlike patient cluster was also identified, reflecting more frequent pressing/tightening pain, mild to moderate pain, bilateral location, and absence of nausea/vomiting. These patient clusters were consistent across subsamples. International Headache Society diagnoses corresponded with classification based upon statistically derived clusters ( P <.001). These results indicate that headache symptoms cluster empirically in a manner consistent with IHS criteria for migraine and tension‐type headaches. Criterion overlap problems regarding pain intensity and duration were identified. Overall, these data support migraine and tension‐type headache as distinct entities, and provide support for the IHS diagnostic criteria with minor modifications.
This article evaluated the ability of propranolol to enhance results achieved with relaxation-biofeedback training. Thirty-three patients were randomized to relaxation-biofeedback training alone (administered in a limited-contact treatment format), or to relaxation-biofeedback training accompanied by long-acting propranolol (with dosage individualized at 60, 120, or 180 mg/day). Concomitant propranolol therapy significantly enhanced the effectiveness of relaxation-biofeedback training when either daily headache recordings (79% vs. 54% reduction in migraine activity) or neurologist clinical evaluations (90% vs. 66% reduction) were used to assess treatment outcome. Concomitant propranolol therapy also yielded larger reductions in analgesic medication use and greater improvements of quality of life measures than relaxation-biofeedback training alone but was more frequently associated with side effects.
