Perceived Stress and Coping Strategies in Headache (Migraine & Tension-Type Headache) Patients

By Najam, Najma; Aslam, Shumaila | Journal of Behavioural Sciences, January 1, 2010 | Go to article overview

Perceived Stress and Coping Strategies in Headache (Migraine & Tension-Type Headache) Patients


Najam, Najma, Aslam, Shumaila, Journal of Behavioural Sciences


Headaches are among the most common modern medical complaints in the general population. Headaches are usually categorized as migraine and tension-type headaches, or a combination of both. In 5 to 10 percent of the population chronic problem is occur with migraine headaches, while around 30 to 40 percent experience chronic problems of tension headaches (Carlson, & Peckham, 2001; Hawthorn, & Redmond, 1998; Baum, Gatchel, & Krantz, 1997a, 1997b).

The migraine, tension-type and cluster headaches are classified as primary headaches with no organicity, and headaches with underlying organic pathology are secondary headaches (Millea, & Brodie, 2002).

Migraine is generally defined as neurological condition where the symptom is a severe and disabling episodic headache, (Cooke, Rose, & Becker, 2000). It is now well documented as vascular disorder, due to loss of tone in the major extra-cranial blood vessels, leading to painful dilation and excruciating pain. Chemicals such as bradykinin or neurokinin are released at the side of the dilated vessels (Baum, Krantz, & Gatchel, 1997a). Migraine has its triggers and is expressed in wither of the three forms, classic migraine, common migraine or complicated migraine (Nowak, & Handford, 2004).

Migraine triggers emerge from a wide range of variables and behavioral, environmental, infectious, dietary, chemical and/or hormonal triggers can precipitate migrainic episodes. Stress, dazzling light, alcohol, food, too much or too little sleep and weather are reported as most frequent factors that trigger migraine attack. Weather has also been reported as one of the frequent precipitators due to sensitivity to weather changes (Prince, Rapoport, Sheftell, Tepper, & Bigal, 2004; Hawthorn, & Redmond, 1998). The Chinook winds of Alberta, Canada are a case of one such migraine trigger (Cook, Rose, & Becker, 2000).

More women as compared to men suffer from migraines. Female hormonal levels may be related to the occurrence of migraine as it has been reported occurrence frequency increases especially around the time of menstruation. Mazal (1978) reports that migraine onset is mostly during pregnancy and can be exacerbated by oral contraceptives. Migraine also appears to have hereditary basis as 80% of migraine sufferers report a family history of migraine.

Low-income or less well-educated have a higher reported occurrence, as well those within age range of 35 and 45 years (Baum, Gatchel, & Krantz, 1997b).

Tension-type Headaches

This pain radiates in a band-like form, from forehead to the occipital lobe area with reported tightness, pressure and dull ache. Tension-type headache have a different symptomology as compared to migraine as the latter appears to be localized in the head and neck muscles and can last for days or weeks (Baum, Gatchel, & Krantz, 1997a, Hatch, 1993; Baum, Gatchel, & Krantz, 1997b, Millea, & Brodie, 2002). Tension headaches may be due to heightened sensitivity to pressure-type pain, (Baum, Gatchel, & Krantz, 1997b). Further, Muscle hardness and pain is also associated with tension-type headache (Millea, & Brodie, 2002). Patients experience a non throbbing pressure, fullness, or stiffness on both sides of the head. The tension-type headache occurs gradually (Nowak, & Handford, 2004).

More women (88%) than men (69%) report tension-type headaches, (Marcus, 2005). It has been reported in our earlier studies women were 68%) of headache patients reporting in outdoor clinics (Tanwir, & Naj am, 1992) and were 73% of the chronic patients (Tanwir, & Naj am, 1994).

Perceived Stress

Perceived stress has been given due importance in the understanding and management of pain. It appears that perceived stress can trigger tension-type headaches. Research has shown that the headaches sufferers perceived higher level of subjective stress, and all the participants who are reported higher level of stress are using disengagement coping style (Myers, Wittrock, & Foreman, 2004). …

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