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SYNOPSIS Muscle contraction headache is associated with sustained contraction of skeletal muscles. Approximately 80 percent of headache sufferers have this form of headache. Behavioral approaches offer a powerful treatment alternative to the use of medication. Studies on the long‐term outcome of effectiveness of biofeedback‐behavioral programs, however, are scarce. The purposes of this paper were twofold: to assess through a survey method long‐term patient progress on headache control 20 months after a specific biofeedback‐behavioral program; and to examine how a personality variable (i.e., expectations of control) might be related to success in headache self‐regulation. Specifically it was hypothesized that patients with an internal locus of control would be more likely to exercise self‐control and rate the biofeedback‐behavioral program higher than externally oriented individuals. A self‐re‐port evaluation questionnaire inquired into the patient's perception of the headache program's effectiveness and the consequent increase or decrease of headache activity. A pain locus of control scale was used as a means to assess the personality variable theses. Of 114 potential subjects contacted, 74 (65%) completed questionnaires for this study. Most 82% of these chronic patients achieved and maintained a significant decrease in overall headache intensity, severity, and duration 20 months after biofeedback‐behavioral treatment. Of variables analyzed, sex, number of sessions attended, age at time of treatment program participation, and locus of control were found significant in influencing the effectiveness of training in reducing headache activity. Chronic patients benefiting most were under 40 years of age and had an internal locus of control. We concluded biofeedback behavioral training is an effective form of therapy in treating chronic muscle contraction headache. The pain locus of control scale appears useful for predicting and possibly selecting patients most likely to succeed in biofeedback‐behavioral headache treatment programs.

SYNOPSIS Muscle contraction headache is believed to result from sustained contraction of muscles involving the neck, scalp, and frontalis musculature. This study stresses the clinical importance of examining neck muscle activity in 16 subjects. Two questions are addressed: (1) Do subjects who in the process of treatment for headaches originating from the neck and who received EMG feedback from frontalis and neck musculature select the neck feedback site as more useful in the control of headache? (2) Is frontalis activity as measured by the EMG a measure of the level of activity in other portions of the skeletal system, namely neck musculature? Results indicate that neck involvement varies significantly among patients complaining of chronic muscle contraction headaches, and that a substantial number of subjects experience far more neck than frontalis activity and benefit from behavioral techniques applied to that area. Our findings indicate that attending specifically to neck tissue is a useful therapeutic goal. Consequently, post‐treatment results show significant reductions in neck tissue muscle activity, especially for patients reporting significant neck symptomatology and/or those with high levels of EMG neck activity who reported that behavioral techniques applied to the neck area were helpful for controlling the muscle activity related to their headaches.

SYNOPSIS Should muscle contraction headache be measured and treated from the traditional bifrontal muscle sites? Fivestudies report significant positive correlations between headache parameters and frontalis surfaceelectromyogram (EMG) levels. In contrast, four sets of authors who analyzed the relationship failed to find asignificant relationship. The purpose of this study is to investigate whether headache and nonheadache EMG levels in chronic musclecontraction headache patients were higher than in nonheadache‐matched controls using both conventional andmore inclusive EMG electrode placement sites. Twenty‐five patients experiencing chronic muscle contraction headache (experimental group) and twenty‐fiveage‐matched nonheadache subjects (control group) comprised this study. Experimental group subjects weremonitored twice while having a headache and twice while not having headache prior to beginning therapy. Datafrom the experimental group were compared with that of the control group who indicated “seldom if everexperiencing headache.” EMG data were collected and statistically compared using the conventional bifrontalmodel, the Cram‐Scan model and a Schwartz‐Mayo profiling method on all persons in this study. Results indicate the Schwartz‐Mayo placement followed by the Cram‐Scan model were superior indisciminating between the headache and nonheadache groups. The most conclusive finding is that the bifrontalplacement model appears antiquated in its ability to provide meaningful diagnostic information and may not besufficient for patient assessment and efficient therapy. Determining the existence of muscle contraction andmodes of treatment may be more effectively reached using multisite EMG monitoring rather than the traditionalbifrontal placement.

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