Tension headache: disregulation at some levels of stress

The prevalence of primary headache disorders and their associated factors among nursing staff in North China

Background

Epidemiological data on the prevalence of headache in nursing staff in Mainland China are lacking. We therefore performed a study to assess the prevalence of headache, and factors associated with headaches, in nursing staff in three hospitals in North China.

Methods

Stratified random cluster sampling was used to select 1102 nurses from various departments in three hospitals. A structured questionnaire was used to collect epidemiological data, headache characteristics and associated factors.

Results

The response rate was 93.0%. Among nursing staff, the 1-year prevalence of primary headache disorders was 45.3%, of migraine 14.8% (migraine with aura 3.4%, migraine without aura 11.4%), of tension-type headache (TTH) 26.2%, of chronic daily headache (CDH) 2.7%. Multivariate analysis showed that seniority (≥5 years) was a risk factor for migraine (OR 2.280), obesity (BMI ≥ 25) was a risk factor for TTH and CDH (OR 1.684 and 3.184), and age (≥40 years) was a risk factor for CDH (OR 8.455). Nurses working in internal medicine were more likely to suffer CDH than those in other departments. Working a greater number of night shifts was also associated with increased prevalence of headache.

Conclusion

The prevalence of primary headache disorders in nurses is higher than that in the general population in China, and occupational factors may play an important role. Therefore, the prevalence of headache in nurses should be a focus of attention, and coping strategies should be provided. Such measures could contribute to improving patient care.

Academic aptitude as a predictor of headache proneness during college: could headache be an outcome of low test scores?

BACKGROUND

Academic work as well as compensated employment has been found adversely associated with frequent headache; headache remains a costly disorder to the person and to society. However, little is known of factors--other than prior headache complaints--that may predict headache frequency over extended periods of time. Based on previous research, effortful task engagement appears to be a contributing factor to headache onset. This suggests that relatively stable attributes that are likely to affect effort expenditure may predict headache frequency over long intervals.

PURPOSE

The goal of this study was to evaluate the predictability of headache proneness in college-attending students by college aptitude tests administered in high school.

METHODS

Five hundred undergraduate students enrolled in a large public, urban university completed a number of questionnaires. Official admissions records of the college aptitude tests ACT (an acronym for the original test name, the American College Testing), SAT (the Scholastic Aptitude Test), and GPA (grade point average) were obtained and compared to the report of headache frequency.

RESULTS

The ACT test mathematics predicted headache proneness in the hypothesized direction, while the ACT English test provided conflicting data; some evidence of gender differences was suggested.

CONCLUSION

While nearly all research on headache and work effectiveness has considered headache to be a cause of reduced efficiency or productivity, this study suggests that a factor which presumably affects the ease of work completion (e.g., scholastic aptitude) may predict headache, at least in some cases within the "work" environment of academia.

Psychophysiological Responses of Female Headache Sufferers and Controls Using a Picture-Viewing Paradigm

Despite the advancement of the biopsychosocial model, the interrelationship between behavioral, emotional, and physiological factors in tension-type headache (TTH) remains unclear. Using a picture-viewing paradigm, the present study investigated differences between females with TTH and controls on physiological reactivity, affective valence and arousal, and oral motor habits. In addition, the concordance between EMG activity and self-reported oral habits (i.e., proprioceptive awareness) and EMG activity and self-reported affect (i.e., affective coherence) were measured using within-subject correlations per individual and then compared between groups. Data were analyzed for 27 TTH sufferers and 27 controls who completed a questionnaire packet followed by a psychophysiological assessment consisting of 3 phases (adaptation, scheduled-viewing, recovery) with EMG activity recorded continuously at 3 sites (frontalis, corrugator, zygomatic). During the scheduled-viewing phase, participants were presented with 24 pictures designed to elicit positive, neutral, and negative affect. Compared to controls, the headache group reported elevations in pain, oral habits, and stress across the 3 phases of the assessment, along with elevations in arousal while viewing the pictures. There were no significant differences between the groups in EMG activity while viewing the pictures. Analyses on concordance revealed partial evidence for poor proprioceptive awareness and affective coherence among the headache group, although the correlations were not significantly different than the control group. These findings suggest that arousal, stress perception, and oral habits may play a role in the pathophysiology of TTH and that within-subject designs should be tested further against group designs when measuring psychophysiological concordance.

[Functional somatic pain syndromes: summary of hypotheses of their overlap and etiology]

Currently it is unclear whether functional somatic syndromes can be explained by one common underlying functional syndrome. In any case it does not seem justified to view functional somatic syndromes as purely psychological disorders (somatized anxiety or depression). Psychiatric comorbidity and life time stress including traumatisations are mainly, but not exclusively responsible for triggering health care utilisation. The lowered pain threshold that can be demonstrated clinically and experimentally in fibromyalgia, irritable bowel syndrome, tension headache and temporomandibular disorders is currently seen primarily as result of an altered central nervous processing of nociceptive input. In addition some results also hint at a disturbance in the hypothalamus-pituitary-adrenal axis. The predominance of female patients can be due to gender specific illness behaviour as well as to estrogen-induced changes in pain sensitivity. In sum, functional somatic syndromes currently are best explained by a biopsychosocial model of predisposing, triggering and maintaining factors. More research is needed particularly to clarify the role of genetic and of cultural factors.

Effects of the headache state on objective and perceived performance

The reduced ability to perform tasks is generally reported by those who experience headache. However, in an experimental study, participants reporting onset of headache chose more ambitious tasks than participants remaining headache free. The purpose of this study was to reevaluate the objective ambition of subjects with headache onset, and to determine if perceptions of expended effort and performance accuracy contributed to this seemingly maladaptive behavior. These effects were evaluated while controlling for headache proneness. A nonclinical sample was used. Measures of ambition, performance accuracy, perceived effort, and perceived accuracy for a headache-developing group (n = 25) and a sex-matched, headache-free group (n = 25) were compared during a series of mental arithmetic problems. Ambition among participants after headache onset was significantly higher than for the control group. There was little indication that inaccurate perceptions of effort or accuracy contributed to the observed heightened ambition. However, perceived accuracy was poorer for the headache-developing group after onset of a headache state. Headache proneness did not eliminate the significance of any relationship between objective or subjective performance and headache state.

Life event stress and headache frequency revisited

Life stress is found to be related to headache frequency in some studies, but not others. Research designs that find a relationship between the two tend to evaluate young subjects and employ large sample sizes. The purpose of this study was to evaluate the relationship between headache frequency and life stress, while considering gender and age differences that may be present in the relationship. In addition, as depression or presence of headache at the time of assessment may influence the report of headache frequency, an attempt to control for these factors was employed. Several self-report measures of headache symptomatology, headache presence, depression, and life stress were completed by 1289 subjects. Negative life event stress was found to be modestly but significantly related to headache frequency. The relationship between the 2 variables was stronger for women than for men and, after the influence of depression and headache state was removed, the relationship between life stress and headache frequency remained significant only for women. In the oldest 10% of the sample, there was no evidence of a relationship between negative life event stress and headache frequency.

The comparison of individuals with recurrent tension-type headache and headache-free controls in physiological response, appraisal, and coping with stressors: a review of the literature

It is widely accepted that stress plays an important role in the experience of tension-type headache. This article reviews the literature in which individuals with recurrent tension-type headache are compared to headache-free controls in the experience and appraisal of stress, psychophysiological response to stress, and coping with stress. A modified and extended version of the transactional model of stress as it might apply to tension-type headache is used to organize the relevant literature. In summary, there is evidence to suggest that individuals with recurrent tension-type headache experience more stressful events and are more sensitive and have a lower threshold to pain. There are some suggestions that headache sufferers may use different coping strategies for stress and pain. There is little evidence of differences in physiological responses to stressful events. The shortcomings of this body of literature are addressed and directions for future research are identified.