Stress-Induced Pain and Muscle Activity in Patients with Migraine and Tension-Type Headache

Abstract

We recorded deep pain and surface electromyographic (EMG) responses to stress in 22 migraineurs during headache-free periods, 18 patients with tension-type headache (TTH), and 44 healthy controls. Sixty minutes of cognitive stress was followed by 30 min relaxation. EMG and pain (visual analogue scale) in the trapezius, neck (splenius), temporalis and frontalis areas were recorded. TTH patients had higher pain responses in temporalis and frontalis (with similar trends for trapezius and splenius) and more potentiation of pain during the test than controls. Migraine patients developed more pain in the splenius and temporalis than controls. Muscle pain responses were more regional (more pain in the neck and trapezius compared with the temporalis and frontalis) in migraine than in TTH patients. TTH patients had delayed pain recovery in all muscle regions compared with controls, while migraine patients had delayed pain recovery in a more restricted area (trapezius and temporalis). EMG responses were not different from controls in headache patients, and EMG responses did not correlate with pain responses. TTH patients had delayed EMG recovery in the trapezius compared with controls and migraine patients. These results support the concept that (probably central) sensitization of pain pathways and the motor system is important in TTH. Less pronounced and more regional (either peripheral or central) trigeminocervical sensitization seems to be important in migraine. Surface-detectable muscular activation does not seem to be causal for pain during cognitive stress either in migraine or in TTH.

Noradrenaline and cortisol changes in response to low-grade cognitive stress differ in migraine and tension-type headache

“…We have previously reported higher pain responses during stress in migraineurs compared to controls [20]. The present paper shows that platelet and plasma NA levels were lower in migraineurs than in controls, suggesting that migraineurs may have noradrenergic hypofunction, potentially related to the mechanism for stress-induced pain.…”

“…The stress test procedure is described in detail in another paper [20], and only a short summary will be given here. The subjects performed a two-choice reaction-time test presented on a PC monitor for 60 min.…”

“…The background data of all the subjects that entered the physiological study have been published previously [20]. Background data on subjects with biochemical data are displayed in Table 1 (due to technical problems, 10 controls, one migraineur and two TTH patients, had no biochemical data).…”

“…It may be argued that these short-lasting stressors are of limited relevance with respect to long-lasting, low-grade stressors often reported to induce headaches in daily life. In the present model [20][21][22], we sought to create a low-grade cognitive stressor in order to simulate real-life stress in an office environment.…”

Long-term benefits of botulinum toxin type A (BOTOX) in chronic daily headache: a five-year long experience

“…Against this background, BoNT-A may be considered as a possible therapeutic choice in TTH management, as suggested by increased muscular tension and tenderness in several TTH patients, together with other factors, both peripheral and central, such as stress and psychopathological factors [7].…”