The role of stressful life events in the persistence of primary headache: major events vs. daily hassles

Benedittis, Giuseppe De; Lorenzetti, Aldo

doi:10.1016/0304-3959(92)90006-w

Cited by 96 publications

(78 citation statements)

References 26 publications

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“…However, when the diagnostic categories were considered it emerged that the significant difference was due entirely to patients with migraine, while patients with chronic headaches ("mixed" and "daily" headaches) did not differ from controls. De Benedictis and Lorenzetti [18] studied patients with recurrent headache (average frequency, 16 days (SD=10) per month) and found that those with chronic tension-type headache and "mixed" headache were more exposed to stressful events than controls or migraine patients. Here, however, the significant differences pertained to "daily hassles" -small problems of daily life -and not major life events.…”

Section: Discussionmentioning

confidence: 99%

Stress and chronic headache

D’Amico¹,

Libro²,

Prudenzano³

et al. 2000

J Headache Pain

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IntroductionIt is a matter of clinical experience that psychological factors, in particular stress, can exert notable effects on primary headaches. Several studies have shown that stress is one of the most common trigger factors for headache, both in migraine and in tension-type headache [1][2][3][4][5]. It is reasonable, therefore, that stress may exert effects on the clinical evolution of these headaches. For example, stressful events may increase headache frequency or promote transformation of an episodic headache into a chronic form. A chronic headache is one present on average more than 15 days per month [6]. A transformed headache is an originally episodic headache that developed into a chronic one.A stressful event is an environmental situation or psychological trauma that compromises or threatens wellbeing. Several models have been proposed to explain how stress can influence headache. More recent theories do not consider stress as a purely exogenous factor but recognise that stressful events can induce objective biological and psychological changes.Stress acts on the body via the endocrine system, autonomic nervous system and immune system [7][8][9]. These systems act as biological integrators in the body, functioning to maintain homeostasis. In turn they are influenced by such factors as genetic makeup or constitution, psychobiological imprinting and the external environment (the sum of physical, emotional and social stimuli). Stressful events affect the brain through inputs from the cortex, subcortical regions, and sensory organs, and from the endocrine system, provoking reactions mediated, principally, by the hypothalamo-hypophyseal-adrenal axis (CRH) and by the locus coeruleus (norepinephrine). The effects of these multifarious hormonal and neurotransmitter changes vary with the duration of the stressful stimulus. Prolonged and repeated exposure to stressful stimuli may lead to permanent functional changes and even to anatomical damage, and can thus assume the role of a pathogenetic agent or illness precursor. Abstract The aims of this study were to assess how stress affects chronic headaches, and in particular to determine whether events play a role in the transformation of an episodic headache into a chronic form. A population of 267 Italian patients with chronic headache (headache present on average more than 15 days per month) was studied. Our results confirm a triggering role of stress on headache. We also found that episodic headache (migraine in most patients, 74.1%) preceded the development of a chronic form in about 90% cases. Among these patients, in 44.8% a stressful event correlated with the transformation. Analysis of these events revealed that minor events played a greater role than major life events, suggesting that patients with transformed headache are characterised by a different way of reacting to stress.

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Section: Discussionmentioning

confidence: 99%

Stress and chronic headache

D’Amico¹,

Libro²,

Prudenzano³

et al. 2000

J Headache Pain

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“…Sensory stimuli such as flickering light and glare are particularly related to migraine with aura and they are less important in migraine without aura and pure TTH [5,6,8,11,12]. Psychological factors, in particular stress, are experienced as a major precipitant of migraine and TTH by many patients [4,8] and this finding was confirmed in prospective and controlled studies [13,14]. It is under debate, however, whether stress is more important in migraine or in TTH [4,8,15].…”

Section: Introductionmentioning

confidence: 93%

Trigger factors of migraine and tension-type headache: experience and knowledge of the patients

et al. 2006

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The objective was to examine potential trigger factors of migraine and tension-type headache (TTH) in clinic patients and in subjects from the population and to compare the patients' personal experience with their theoretical knowledge. A cross-sectional study was carried out in a headache centre. There were 120 subjects comprising 66 patients with migraine and 22 with TTH from a headache outpatient clinic and 32 persons with headache (migraine or TTH) from the population. A semistructured interview covering biographic data, lifestyle, medical history, headache characteristics and 25 potential trigger factors differentiating between the patients' personal experience and their theoretical knowledge was used. The most common trigger factors experienced by the patients were weather (82.5%), stress (66.7%), menstruation (51.4%) and relaxation after stress (50%). The vast majority of triggers occurred occasionally and not consistently. The patients experienced 8.9±4.3 trigger factors (range 0-20) and they knew 13.2±6.0 (range 1-27). The number of experienced triggers was smallest in the population group (p=0.002), whereas the number of triggers known did not differ in the three study groups. Comparing theoretical knowledge with personal experience showed the largest differences for oral contraceptives (65.0 vs. 14.7%, p<0.001), chocolate (61.7 vs. 14.3%, p>0.001) and cheese (52.5 vs. 8.4%, p<0.001). In conclusion, almost all trigger factors are experienced occasionally and not consistently by the majority of patients. Subjects from the population experience trigger factors less often than clinic patients. The difference between theoretical knowledge and personal experience is largest for oral contraceptives, chocolate and cheese.

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“…This raises the possibility that activation of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis in response to stress may be important in TTH pathogenesis. Sympathetic hyperactivity has been implicated in other pain disorders such as fibromyalgia [61], and a number of studies have demonstrated differences in short-term nervous system response between TTH patients and controls in response to stress [75][76][77].…”

Section: Genetics and Neurobiologymentioning

confidence: 99%

Tension-Type Headache: A Life-Course Review

Waldie

Buckley²,

Bull³

et al. 2015

Journal of Headache &Amp; Pain Management

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Background: Tension-type headache is the most prevalent primary headache type worldwide and is associated with a wide spectrum of disability. Although progress has been made in understanding the complex mechanisms that lead to the pathogenesis of tension-type headache, to date there are no clear-cut markers of what makes tension-type headache unique. Due to a relative lack of research (compared to migraine), the pathophysiology of tension-type headache is not well understood and there are gaps in the epidemiological data, particularly from Australasia.

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The role of stressful life events in the persistence of primary headache: major events vs. daily hassles

Cited by 96 publications

References 26 publications

Stress and chronic headache

Stress and chronic headache

Trigger factors of migraine and tension-type headache: experience and knowledge of the patients

Tension-Type Headache: A Life-Course Review

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