OBJECTIVES: We aimed to evaluate the efficacy of biofeedback-assisted autogenic training for chronic tension-type headache, and to determine the relationship among the changes in electromyography (EMG) activity, headache activity, and mood states according to the psychophysiological treatment. METHODS: Chronic tension-type headache patients aged from 20 to 40 years (n=35) were randomized to the treatment group receiving biofeedback-assisted autogenic training (8 sessions) or the monitoring-only control group. EMG activities, headache index, and various psychological variables were examined. RESULTS: We found greater treatment response rate (> or =50% reduction in headache index) in patients with biofeedbackassisted autogenic training than in the monitoring group (61% vs. 18%; chi-square=6.882, df=1, p=0.01). There were no significant changes in the mean values of the pretreatment EMG activities across the sessions in either group (all p's>0.1). Mood states including anxiety and depression improved over time in the both groups, with the improvements being more prominent in the treatment group. Moreover, the reduction in depression level predicted treatment outcome in terms of headache index (95% confidence interval: 0.272-0.966, p=0.039). CONCLUSION: These results show that biofeedback-assisted autogenic training is effective for the treatment of chronic tension-type headache in a Korean population. Changes in mood states may be closely associated with the clinical outcome in the treatment of chronic tension-type headache using biofeedback-assisted autogenic training.
Aged ; Anxiety ; Autogenic Training ; Biofeedback, Psychology ; Depression ; Electromyography ; Headache ; Humans ; Tension-Type Headache ; Treatment Outcome

BACKGROUND: Psychosocial factors exert a significant influence on primary headaches. However, little has been known about the agreement concerning the extent and nature of psychological processes on migraine and tension-type headache (TTH). METHODS: Fifty-five patients with primary headache were enrolled to participate in the study and 33 headache-free control subjects. A depression scale (BDI), an anxiety scale (STAI), a psychopathology scale (SCL-90-R), a stress coping scale (MCS), and a quality-of-life scale (WHOQOL-BREF) were administered to all the participants. RESULTS: The headache sufferers turned out to have various emotional problems, used more inefficient stress coping strategies and lead poor quality of life compared with those who had no headache. No distinctive psychological symptom was found between the two diagnosis groups, but the migraine group showed higher obsessive-compulsive symptoms than the TTH group, and the latter group showed higher levels of trait anxiety than the former. CONCLUSIONS: This study shows that the primary headache sufferers have various psychosocial problems. Accordingly, individual treatment approach focusing on the psychological symptoms is needed for the efficient management of headache.
Anxiety ; Depression ; Diagnosis ; Headache ; Humans ; Migraine Disorders* ; Psychology ; Psychopathology ; Quality of Life ; Tension-Type Headache*

Headache is one of the meet common symptoms in neurological outpatient clinic. It is not so easy for physicians and neurologists to manage headache, especially if it is chronic although it seldom causes serious problem. There are many psychological factors known to induce, maintain and aggravate symptom in patients with chronic headache. Thus it is necessary to identify these factors in each patient when planning therapeutic strategies. In order to assess the influence of psychological characteristics, such as depression, anxiety and stress, on therapeutic outcome in patients with chronic headache, I performed Beck depression inventory (BDI), General assessment of recent stress scale (GARS) and State-trait Anxiety inventory (STAI) in 13 patients with migraine, 14 with tension-type headache and 29 with unclassified headache, meet of whom are with mixed or chronic daily headache. In all patients the duration of headache is more than one year. The effect of therapy (flunarizine + amitriptyline or moclobemide) was assessed using self-rating headache index after three months. Patients in unclassified group were significantly older and had longer duration of symptoms than other groups. While GARS and STAI scores were comparable among groups, the BDI score in unclassified group was significantly higher than other groups. The therapeutic response was relatively poor in patients in unclassified group and patients with long-term analgesics abuse, compared with other groups. The poor responders to therapy showed higher BDI and STAI more than moderate as well as good responders. Sbepwise regression analysis was performed to exclude interactions between psychological characteristic, and it revealed depression is the strongest variable influencing therapeutic outcome. These results suggest; first, there are no significant differences in psychological characteristics between migraine and tension-type headache; second, patients with depressive trait are prone to have chronic daily headache; third, among the psycholog
Ambulatory Care Facilities ; Amitriptyline ; Analgesics ; Anxiety ; Depression ; Headache ; Headache Disorders* ; Humans ; Migraine Disorders ; Psychology ; Tension-Type Headache

OBJECTIVES: This study aimed to examine the effect of biofeedback treatment on the clinical symptoms and stress responses in chronic headache patients. METHODS : We recruited 18 chronic headache patients who were treated with 8 sessions of biofeedback treatment and 18 age and sex-matched control headache patients. All subjects consisted of patients with chronic tension headache and migraine headache. Stress responses were measured using Symptoms of stress (SOS) inventory and all subjects performed Beck depression inventory (BDI), Spielberger state anxiety inventory (STAIS), and visual analogue scale (VAS). Biofeedback physiological variables including frontal and forearm EMG, electrodermal response (EDR) and skin temperature at pre-and post-treatment were also measured in all subjects. RESULTS : Compared with control patients, patients on biofeedback treatment showed significant reduction in scores of STAIS (t=3.705, p<.001), and VAS (t=3.392, p=.001) as well as SOS subscales;peripheral manifestations (t=1.788, p=.042), habitual patterns (t=2.008, p=.027), depression (t=2.081, p=.023), anxiety (t=1.990, p=.028), and total score (t=2.045, p=.025). There was a significant increase of skin temperature (t=-1.835, p=.038) only in the biofeedback treatment group. CONCLUSION : These results suggest that biofeedback treatment may be effective in relieving chronic headache by reducing psychological and physiological stress responses.
Anxiety ; Biofeedback, Psychology ; Depression ; Forearm ; Galvanic Skin Response ; Headache ; Headache Disorders* ; Humans ; Migraine Disorders ; Relaxation* ; Skin Temperature ; Stress, Physiological ; Tension-Type Headache

Chronic headache is commonly encountered in the neurology outpatient clinic and it is often associated with depression. In Korea, however, chronic headache has not yet been systematically investigated. We conducted this study to investigate this clinical characteristics and level of depression in patients who presented migraine, tension-type headache, or transformed migraine. METHOD: Among those with chronic headache during the period from January 1, 1994 through December 31, 1994, 131 patients were diagnosed to have either migraine, tension-type headache (by IHS classification), or transformed migraine: migraine in 60 patients, tension-type headache in 49 patients, and transformed migraine in 22 patients. Beck Depression Inventory (BDI) was performed in 116 of the 131 patients. RESULTS & CONCLUSION: There was no significant difference in the age of onset, duration of headache, and family history among the three groups. However, patients with migraine had a more severe, unilateral, and throbbing characteristic pain than those with a tension-type headache. The mean BDI scores in the transformed migraine and the tension-type headache patients were significantly higher than those of migraine, but the level of depression did not correlate with the patient's age, duration, character, severity, and frequency of headache. These findings suggest that migraine, tension-type headache and transformed migraine may be considered clinically distinct entities in viewing their different clinical characteristics and level of depression.
Adolescent ; Adult ; Aged ; Child ; Chronic Disease ; Comparative Study ; Depression/*psychology ; Female ; Human ; Male ; Middle Age ; Migraine/*psychology ; Support, Non-U.S. Gov't ; Tension Headache/*psychology