Psychological Aspects of Weekend Headache Sufferers in Comparison with Migraine Patients

Abstract

Sometimes the relaxation after stress may trigger a migraine attack. This is the principle that underlies that particular variant of migraine called "weekend headache". We hypothesize the presence in weekend headache prone subjects of a particular psychological background, different from that of common migraine sufferers. In order to detect possible differences supporting our hypothesis, we studied 104 new outpatients: 46 patients suffering from headache only on weekends (23 males and 23 females) and 58 matched common migraineurs (26 males and 32 females) with no weekend predilection. The psychological assessment was performed using the following psychometric tools: MMPI, BDI, STAIX1-X2. A clinical assessment of each patient was also carried out. Significant differences were found after statistically analyzing the test results. Most of the MMPI scales were found to be more elevated in both male and female weekend headache sufferers. From a clinical point of view, the weekend headache attacks proved to be similar to those of common migraine, but with a significantly higher incidence of concomitant symptoms. Our study confirms the important role that psychological factors play in the pathogenesis and clinical development of migraine and leads us to conclude that a psychic tension component is associated with the vascular one in weekend headache.

The Biochemical and Neuroendocrine Bases of the Hyperalgesic Nocebo Effect

“…The subjects were tested with the State-Trait Anxiety Inventory (STAI) to rule out both trait and state anxiety. In the Italian population, the normal STAI-S range is 45.2 Ϯ 12.37 for adult women and 40.17 Ϯ 10.01 for men, whereas the STAI-T normal range is 46.1 Ϯ 11.53 for women and 39.53 Ϯ 9.25 for men (Spielberg et al, 1980;Nattero et al, 1989). In our routine clinical experience, these values correspond to a range of ϳ32-52 for the STAI-S and ϳ30 -55 for the STAI-T.…”

Reduction in perceived stress as a migraine trigger

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Premonitory features include changes in mood or behavior that precede the onset of an attack. Trigger factors, measurable precipitants associated with an increased probability of an attack, can include stressful events, hormonal changes, weather changes, and certain foods, although some studies demonstrate reduced odds for migraine attacks in relation to certain variables.…”

“…Trigger factors, measurable precipitants associated with an increased probability of an attack, can include stressful events, hormonal changes, weather changes, and certain foods, although some studies demonstrate reduced odds for migraine attacks in relation to certain variables. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] In patient surveys, perceived stress was associated with migraine onset in up to 80% of respondents. [13][14][15][16] Diary studies have shown that "daily hassles" significantly increase in the 2-to 3-day period before a migraine day.…”

“…4 Some studies have examined the effects of reduction in stress or "let-down" as a migraine trigger factor, often focused on "weekend" headache attacks. [14][15][16][17][18][19][20][21][22] The roles of level of stress and reduction in stress as migraine triggers remain to be disentangled. Our objective was to examine the association between stress and reduction in stress on migraine attack onset in persons with migraine using electronic diaries.…”

“…Results demonstrate that electronic diaries coupled with appropriate analytic strategies provide a powerful tool for assessing headache triggers. [11][12][13][14][15][16][17][18][19][20][21][22] Random-effects logistic regression modeling provides more accurate summaries of effects both within and among participants. Methodologic issues in studying stress and relaxation after stress exemplify the problems that arise for studying provocative factors for migraine in general.…”