Depression increases onset of tension-type headache following laboratory stress

Abstract

The aim of this study is to examine the influence of depression on headache onset following laboratory stress and on psychophysiological variables associated with tension-type headaches (TTHs). Diagnostic interviews identified three groups: headache prone and depressed (HP/D, N = 13); headache prone not depressed (HP/ND, N = 22); and healthy controls (HC, N = 13). Ss completed a laboratory stress task. Blind evaluations of pericranial muscle tenderness (PMT) and pressure pain thresholds (PPT) were obtained immediately before, immediately after and 24 h post-task. Ss also recorded headaches (HA) before, during, immediately post-task and for 24 h post-task. HP/D Ss were more likely than HP/ND Ss or HC Ss to report a headache during and immediately following the stress task (P < 0.05). HP/D Ss exhibited higher PMT than HP/ND Ss or HC Ss before and following the stress task (P < 0.05). HP/D Ss exhibited lower finger PPT at all assessments and lower temporalis PPT at two of three assessments than HC Ss (P < 0.05) but did not significantly differ from HP/ND Ss at most assessments. Depression increased vulnerability to TTH following laboratory stress and was associated with elevated PMT. In individuals with frequent headaches, depression may aggravate existing central sensitization increasing vulnerability to TTHs.

Pathophysiology of tension-type headache

“…Moreover, behavioral and psychologic therapies have been shown to be effective for the treatment of TTH [11•]. Janke et al [12] demonstrated that depression increased vulnerability to TTH in patients with frequent headaches during and following the laboratory stress test and was associated with elevated pericranial muscle tenderness. It was suggested that anxiety and depression may contribute to increased excitability in central nociceptive pathways in patients with CTTH [12,13].…”

“…Janke et al [12] demonstrated that depression increased vulnerability to TTH in patients with frequent headaches during and following the laboratory stress test and was associated with elevated pericranial muscle tenderness. It was suggested that anxiety and depression may contribute to increased excitability in central nociceptive pathways in patients with CTTH [12,13]. The neurobiologic mechanisms through which emotional factors promote TTH are unknown and further studies are needed to explore the possible relation of corticolimbic circuits to sensitization of nociceptive pathways in TTH.…”

Behavioral and psychologic aspects of the pathophysiology and management of tension-type headache

“…Anxiety or depression may contribute to the sensitization of pain transmission circuits [12,18]. For example, depression was associated with elevations in pericranial muscle tenderness, reductions in peripheral pain tolerance, and an increased likelihood that patients would experience tension-type headaches after laboratory psychologic stress [18].…”

“…For example, depression was associated with elevations in pericranial muscle tenderness, reductions in peripheral pain tolerance, and an increased likelihood that patients would experience tension-type headaches after laboratory psychologic stress [18]. Thus, depression or anxiety may increase vulnerability to or maintain frequent tension-type headaches by aggravating the central sensitization in pain transmission pathways, and through associated muscle tension that elevates peripheral input.…”

Chronic tension-type headache

“…Patients with CTTH also have higher rates of catastrophizing and avoidance [9••]. Depression and anxiety may contribute to the already existing disorder in patients with CTTH, causing a decreased threshold for pain and a higher frequency of headache [10]. The severity of headache also increases signifi cantly with higher frequency [6].…”