SYNOPSIS Muscle contraction headache and migraine patients were compared for symptoms of muscular and vascular activity, and responsiveness to frontalis electromyogram (EMG) biofeedback therapy. Locations of head pain were non‐specific to the diagnostic groups. Migraine patients had higher frontalis EMG activity than muscle contraction headache patients and headache‐free controls. Both headache groups had higher neck EMG activity than controls. Pulse velocities in the superficial temporal arteries were similar in the two headache patient groups but different from controls. It is suggested that muscle contraction headache and migraine patients have similar physiologic predisposition for headaches. Further support for similar predisposition in the two groups was provided by the frontalis EMG biofeedback results which showed this treatment to be equally effective for both groups.

A psychobiological model of headache is proposed which integrates the numerous aspects of headache research within a unitary conceptual framework. Central to the model is the development of a predisposition for headache that becomes more extensive and more autonomous in function as the disorder increases in severity and chronicity. Guided by the model, the present study examined the prevalence of musculoskeletal, vascular, and autonomic symptoms in a group of chronic headache patients and in a group of occasional headache sufferers. The symptoms were assessed by a 14-item questionnaire that permitted the respondents to indicate the extent to which each of the symptoms was perceived to be present across all headache attacks. In addition, a single item was included to assess the extent to which the respondents perceived their headache attacks to be a problem. The data indicated that the primary difference between the chronic and non-chronic headache sufferer was in terms of the frequency with which the different symptoms occurred rather than in terms of the kind of symptoms present. A stepwise regression analysis revealed that the symptom of nausea with the addition of four musculoskeletal symptoms accounted for 57.3% of the variance associated with the extent to which respondents perceived their headaches to be a problem. These data were interpreted as supportive of a severity model of chronic headache.

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SYNOPSIS A cognitive behavioral treatment study based on 45 chronic headache patients is presented. The sample included patients who had been diagnosed as suffering from muscle contraction, migraine or combined muscle contraction‐migraine headaches. The treatment procedure followed Meichenbaum's cognitive theory of self‐control and had, as its theoretical basis, a psychobiological model of headache. Patients were given individual training in the use of behavioral and cognitive techniques which were designed to modify the sensations, thoughts, and feelings identified by the patients as forming part of their headache syndrome. Treatment effectiveness was examined in relation to a number of topographical characteristics of each patient's headache pattern. The topographical data were collected with a self‐observation record which provided information with respect to: duration of attacks, intensity of pain, time of onset, proportion of attacks associated with various head pain locations, presence of associated headache symptoms and medication usage. The results showed a significant overall treatment effect that was maintained at 6‐month follow‐up. An analysis of covariance revealed that the treatment gains were similar across diagnostic groups. Treatment gains were also found to be largely independent of the headache parameters obtained from the self‐observation record. Head pain locations and symptoms thought to be diagnostic of migraine and muscle contraction headache were not predictive of response to treatment. However, it was observed that headache patients who experienced continuous or near‐continuous pain during their waking hours were not responsive to the treatment procedure. The significance of these findings for the behavioral management of headache is discussed along with their significance for understanding the psychobiological processes controlling chronic headache. The authors wish to express their gratitude to Merleen Hodgson for her contributions to this project.

We sought to determine whether women's attitudes and concerns, confidence in ability to control pain, and practice of pain-control techniques would predict pain and coping or distress-related thought during labor. During the third trimester of their pregnancies, 115 women completed the prenatal self-evaluation inventory and measures of confidence and practice of pain-control techniques. During the latent (less than or equal to 3 cm), active (4-7 cm), and transition (greater than or equal to 7 cm) phases of labor, interviews were conducted to assess levels of pain and the content of women's cognitive activity on a continuum that ranged from coping-related thought to distress-related thought. Women's confidence in their ability to use relaxation techniques and their reported practice of pain-control strategies did predict lower levels of pain and greater coping-related thought during latent labor, but failed to account for pain or coping-distress in active or transition phases of labor. High scores on the Prenatal Self-Evaluation Inventory fear of pain and helplessness scale predicted high levels of distress during latent labor. Two other scales, concern for self and baby and acceptance of pregnancy, were significant predictors of pain and distress in active and transitional labor. The results suggest that, with the shift from latent to active labor, women's fundamental concerns and anxieties become manifest, and may take precedence over the skills acquired through childbirth education in moderating experienced pain and distress.