Psychophysiologic Response Patterns in Tension Headache: Effects of Tricyclic Antidepressants

Abstract

Tension headache (TH) and control subjects (n = 22, 11 in each group) were evaluated within a habituation experimental design, in which psychophysiologic responses to auditory stimulation were measured. Auditory stimuli were 20 80-dB, 1000-Hz tones, each lasting 2 sec and sounded at irregular intervals. Subjects were evaluated twice, with a 6-month interval. At the time of the first session TH subjects were being treated with tricyclic antidepressant, yielding a positive clinical effect. Medication was withdrawn 3 weeks before the second session. Phasic responses in heart rate and temporal artery pulse amplitudes and averaged EMG levels from the frontal muscles were measured. Significantly lower heart rate reactivity and significantly less pronounced left temporal artery pulse amplitude responses were found in non-medicated TH subjects than in controls. TH patients showed a pulse amplitude increase in response to stimulation, whereas control subjects showed a decrease. The pulse amplitude response pattern was normalized in medicated TH patients. EMG levels were similar in TH patients and controls when patients were receiving medication, whereas TH patients showed significantly higher frontal EMG levels than control when medication had been withdrawn.

Psychophysiologic Response Patterns in Migraine Before and After Temperature Biofeedback: Prediction of Treatment Outcome

“…The PWA response pattern observed was different from the pattern seen in TH patients, when studied under comparable laboratory conditions (5). TH patients showed a PWA increase as response to stimulation, whereas migraine patients showed a decrease.…”

“…However, EMG levels were significantly increased in migraine patients after treatment. EMG levels observed at this point were higher than those found in TH patients when studied within an identical laboratory design (5). We have no satisfactory explanation of this finding and conclude that frontal muscle EMG levels in migraine and in TH patients are as high as, or higher than, those in control individuals.…”

“…In general, the traditional view attributing migraine to vasomotor dysfunction and tension headache (TH) to muscle contraction in the head region has received only partial support in psychophysiologic studies (1-3). It has been demonstrated that abnormal vasomotor responses are present in both TH and migraine (4,5) and that migraine patients may show electromyographic (EMG) levels equal to those of TH patients, both during stress and rest periods (6). A review of the literature concerning psychophysiologic responses in migraine patients partly provides supportive evidence for the early observations (7) with regard to abnormal vasomotor responses (2,6,8,9).…”