The present study examined the psychological test responses of 99 headache sufferers and 30 matched nonheadache controls. Headache subjects were of four types: migraine (n = 26), muscle contraction (n = 39), combined migraine-muscle contract ion (n = 22), and cluster (n = 12). Measures consisted of the Minnesota Multiphasic Personality Inventory, a modified hostility scale derived from the MMPI, Back Depression Inventory, State-Trait Anxiety Inventory, Autonomic Perception Questionnaire, Rathus Assertiveness Schedule, Social Readjustment Rating Scale, Psychosomatic Symptom Checklist, Schalling-Sifneos Scale, Need for Achievement, and Hostile Press. Significant differences were found on five clinical scales of the MMPI--1, 2, 3, 6, and 7. Of the non-MMPI scales, only the Psychosomatic Symptom Checklist and Trait Anxiety Inventory were significant. Control subjects revealed no significant findings on any tests. The headache groups fell along a continuum, beginning with cluster subjects, who showed only minimal distress, continuing through migraine and combined migraine-muscle contraction, and ending with muscle contraction subjects, who revealed the greatest degree of psychological disturbance. However, none of the headache groups could be characterized by marked elevations on any of the psychological tests, which contrasts with past research findings. It is suggested that the present results may be more representative of the "typical" headache sufferer.

After a 4-week baseline period during which daily ratings of headache activity were made and all participants took several psychological tests, 91 patients with chronic headache (33 tension, 30 migraine, and 28 combined tension and migraine) were given a 10-session relaxation-training regimen. Patients who did not show substantial reductions in headache activity from the relaxation therapy were given a 12-session regimen of biofeedback (thermal biofeedback for vascular headaches, frontal electromyograph biofeedback for tension headaches). Relaxation therapy alone led to significant improvement for all three headache groups, with a trend for the tension headache group to respond the most favorably. Biofeedback therapy led to further significant reduction in headache activity for all who received it, with a trend for combined migraine and tension headache patients to respond the most favorably. Overall, 73% of tension headache patients and 52% of vascular headache patients were much improved. Multiple regression analyses revealed that approximately 32% of the variance in end-of-treatment headache diary scores could be predicted after relaxation and that 44% of the variance after biofeedback could be predicted using standard psychological tests. Moreover, over 72% of each headache group could be correctly classified as successful or not successful using the same tests in discriminant function analyses.Chronic recurring headache of either the Freundlich, & Meyer, 1975; Holroyd, Antension or vascular variety is a widespread drasik, & Noble, 1980). To date, this literhealth problem in this country afflicting up ature includes approximately 12prospectiveto 40% of the adult population (Ziegler, controlled trials involving tension headache Hassanein, & Couch, 1977). The last 10 and 8 similar trials for migraine headache, years have witnessed an ever-growing liter-The two principal nonpharmacological ature on the nonpharmacological treatment treatments for headache are varieties of bioof headache (Adams, Feuerstein, & Fowler, feedback training and several types of re-1980; Blanchard, Ahles, & Shaw, 1979). laxation training. Numerous controlled, di-This work has included several large-scale, rect comparisons of these two procedures uncontrolled retrospective studies (e.g., Ad-have generally shown them to be equally ler & Adler

Zolmitriptan nasal spray is highly effective in the acute treatment of migraine and has a very fast onset of action, producing significant headache response and pain-free rates as early as 15 minutes post-dose (the earliest assessment in this study). In addition to the very fast onset of action, zolmitriptan nasal spray produced significantly higher sustained headache response and pain-free rates at 24 hours post-dose compared with placebo. These desirable efficacy outcomes were combined with good tolerability.

Following behavioral treatment, 55 successfully treated headache sufferers were randomly assigned to one of two follow-up conditions: regular contact or booster treatment. Subjects assigned to regular contact were asked to continue daily monitoring of headache activity and home practice and were seen in the office for a brief visit (10-15 min maximum) on a monthly basis for 6 months. Subjects assigned to booster treatments received a full session of treatment during their six monthly visits. The progress of all subjects was followed through I year. Headache diary records and interviews with patients and significant others revealed no major differences between conditions, indicating regular contact may be an efficient procedure for maintaining treatment gains. In addition, subjects attributed a number of positive side effects to treatment; no negative side effects were reported by any subject. Home practice was found to be unrelated to maintenance. The significance of these findings is discussed.