The treatment of tension headache—I. Muscular abnormality and biofeedback

The specificity and efficacy of a short EMG biofeedback treatment were assessed in a selected group of chronic tension-headache cases—those having significantly elevated levels of muscle tension. The effects of training patients to raise/maintain EMG levels were compared to those obtained from patients who were trained to lower tension levels. The results showed little evidence of increased self-control of the muscle despite successful EMG control during six bio-feedback sessions. A progressive and significant reduction in resting level was found only in the groups trained to reduce EMG levels. The treatment proved ineffectual in reducing headache. The implications of the dissociation of muscle tension and headache are discussed both with respect to current views of tension headaches and the role of biofeedback in their treatment.     

Social problem‐solving,perceived stress,depression and life‐satisfaction in patients suffering from tension type and migraine headaches

This study aimed at investigating social problem solving, perceived stress, depression, and life‐satisfaction in patients with tension type and migraine headaches. Forty‐nine migraine and 42 tension type headache patients (n = 91) consenting to participate were compared to a total of 49 matched healthy control group. Participants filled in a questionnaire consisting self‐report measures of problem solving, perceived stress, depression and life satisfaction. They were also asked about headache duration, frequency, pain severity, psychiatric treatment and sense of control in one's life. T‐tests, chi‐square, analysis of variance, logistic regression analysis and Pearson product moment correlation coefficient procedures were used to analyze the data. Tension type headache patients reported having had more frequent headaches than the migraine patients but migraine patients reported having had more intense pain than the tension type headache patients. Instances of psychiatric treatment were more common among tension type headache patients than the migraine and the control group. Compared to the healthy controls, headache patients displayed a deficiency in problem solving, higher levels of perceived stress and depression. Levels of problem solving skills in headache patients were related inversely to depression, perceived stress and the number of negative life events but problem solving skills of headache patients was related positively to life‐satisfaction. The findings from this study suggested that cognitive behavioral problem solving therapy or training might be a viable option for reducing levels of stress and depression, and to increase life‐satisfaction in patients suffering from primary headache.     

Relationship between self-reported intensity of headache and magnitude of surface EMG

The study was designed to examine the relationship between self-reported intensity of headache and surface EMG. 98 patients, diagnosed by their neurologists with "muscle-contraction headaches" (tension-type headaches) were referred to evaluate their suitability for biofeedback therapy. At the time of examination, they were asked to rate their average headache intensity on a 10-point scale. Surface EMG data were collected to assess actual muscle contraction. Analysis indicated that among patients diagnosed with muscle contraction headache, there is a positive significant correlation between self-reported intensity of headache and actual muscle-contraction. The current data lend support to the hypothesis that the tension in the headaches currently described as "tension-type" may in fact refer to actual muscular tension or contraction.     

Physiologic and self-report comparisons between tension headache sufferers and nonheadache controls

Tension headache sufferers and nonheadache controls were compared with respect to (1) frontal EMG during both baseline and presentation of an imagined stressor, (2) trait anxiety, (3) locus of control expectancies for health related behaviors, and (4) exposure to stressful life events. Tension headache sufferers displayed higher resting muscle tension levels than did nonheadache controls. However, both groups responded similarly to the imagined stress stimulus and displayed significant muscle tension elevations of similar magnitude. While tension headache sufferers reported higher levels of trait anxiety, no differences were found between the two groups for locus of control expectancies and exposure to stressful life events. The diagnostic and treatment implications of these findings are discussed.     

The treatment of tension headache—II. EMG ‘normality’ and relaxation

A selected group of patients complaining of severe and chronic tension headache (without muscular abnormality) were given a short 3-week course of relaxation treatment. Half of the subjects received progressive relaxation instructions, while the other half received relaxation plus calming imagery. Both groups showed substantial improvements in pain behaviour and in pain experience. The improvements were synchronous and still present at the 6–8 week follow-up assessment. Although no significant differences were found between the groups, the addition of imagery appeared to produce larger improvements on a number of measures. These results were compared with those reported obtained in a previous biofeedback study and the implications of both the studies were discussed with respect to tension headache and its treatment.     

The modification of tension headache pain using EMG biofeedback

In a controlled trial of the effects of biofeedbaek on patients with tension and mixed tension-migraine headaches, biofeedback proved superior in producing decrements in resting muscle tension levels, headache intensity, medication frequency, and a slight decrement in headache frequency. The time course of the changes in these systems was discussed. Pseudo-biofeedback produced little change. Tension and mixed tension-migraine cases responded differently. The latter learned muscle tension reduction less easily, although their onset levels were high, and they gained less benefit with respect to pain reduction from their training.     

Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or,the machines may be necessary some time of the time

Two studies are reported in which patients with chronic headache, who did not improve significantly as a result of a 10-session, 8-week relaxation training program, were subsequently treated with biofeedback. For the tension headache sufferers, 36% of the relaxation non-responders showed significant improvement with frontal EMG biofeedback training. For those with vascular headaches, 44% of the relaxation non-responders showed significant improvement with thermal biofeedback. Vascular headache patients with combined migraine and tension symptoms did better than those with only migraine. Psychological test scores significantly differentiated successful vs non-successful biofeedback responders.     

Medikamentenübergebrauchs­kopf­schmerz

Prospective longitudinal studies clearly demonstrate a causal relationship between the overuse of painkillers and migraine relievers and chronic headache. Overuse of any acute headache medication is the main factor in about 30-50% cases for chronic headache, and thus chronic headaches may be attributed to overuse. The prevalence of medication overuse headache (MÜKS, Eng: medication overuse headache, MOH) is likely to be around 3%.The diagnostic criteria of MOH are: Headache more than 15 days per month, Regular overuse of one or more drugs for acute symptomatic headache treatment of over more than 3 months, Headache has developed or is aggravated during medication overuseHeadache disappears or reverts to its initial level within 2 months after discontinuation of the drug overuse. Clinically, it is usually a “mixed” holocranial headache that is no longer consistent with a migraine or tension headache. The so-called “swing model” has proven itself in the context of psychoeducation. If painkiller withdrawal is not possible, in the outpatient setting, then a stationary multimodal withdrawal therapy should also be considered.     

Relaxation therapy for tension headache in the elderly: a prospective study

We evaluated the effects of an 8-week progressive muscle-relaxation therapy regimen on the headache activity of 10 elderly tension-headache subjects. Posttreatment assessment at 3 months revealed significant decreases in overall headache activity (50% or greater) in 7 subjects. Significant clinical or statistical prepost differences, or both, were also found for the number of headache-free days, peak headache activity, and medication index. This is the first prospective study of tension headache in an elderly population, and, unlike previous retrospective studies, it suggests that relaxation therapy may be an effective intervention in the treatment of such headaches.     

Electromyographic and vasomotor activity in tension, migraine, and combined headache patients: The influence of postural variation

Electromyographic (EMG) and temporal artery vasomotor activity was evaluated in three groups of headache patients (tension, migraine and combined) and nonheadache control subjects while in reclining, sitting and standing positions. Analysis of the EMG data revealed that at all measurement sites (bilateral frontalis, bilateral trapezius) the three headache groups demonstrated significantly higher levels than the nonheadache group but did not differ from each other. A secondary analysis of the trapezius EMG data revealed that a large percentage of headache patients had “normal” EMG levels in the reclining position but showed abnormalities in the sitting and standing positions. Analysis of the left temporal artery vasomotor activity revealed that all three headache groups vasoconstricted to a significantly greater extent than the nonheadache group in the sitting and standing positions. However, a diagnosis by position interaction was found for the right temporal artery with the migraine group demonstrating a unique pattern of activity.     

Pathomechanisms of cervical headaches

Various types of disorders of the cervical region may produce headache. In many of these increased tension of the neck musculature plays an important role. The following mechanisms underlying headache are described and differentiated: 1. Headache due to faulty muscle pattern (stereotype) resulting in overstrain of the upper fixators of the shoulder girdle (upper part of the m.trapezius and levator scapulae); faulty respiration with the aid of the upper auxillary muscles even at rest is pointed out. 2. A forward drawn head position producing static overstrain in the posterior neck muscles and compensatory retroflexion of the cranio-cervical junction resulting in blockage in this region. 3. Anteflexion and ligament pain mainly due to faulty position at work and jolting. 4. Static disturbance in the frontal plain due to obliquity producing asymmetrical strain in the neck musculature. 5. Increased muscular tension due to psychological stress. 6. Blockage in the regions of the cervical spine, shoulder girdle and upper ribs with reflex muscular spasm. 7. Reflex spasm of the neck musculature in visceral disorders causing in addition blockage of the cervico-thoracic junction (heart, gall bladder). 8. Pain arising from the posterior arch of the atlas (here described for the first time). 9. Headache due to vertebral artery involvement. The type of headache seems to be determined rather by the individual mode of reaction than by the mechanism underlying it. As a rule a combination of mechanisms is actually found.     

Stress reactivity and perception of pain among tension headache sufferers

Twenty-one tension headache sufferers and 21 control subjects were exposed to a series of psychological stressors and an ischemic pain task, involving a tourniquet around the arm. Compared to control subjects, headache patients showed higher heart rates and evidence of more prolonged vasoconstriction in the hands and the ear lobe. No between-group differences in EMG were found, however. Headache patients rated the tourniquet as more painful than did control subjects, and described themselves as more anxious, angry, and depressed. The pattern of results is consistent with the interpretation that headache patients are emotionally and autonomically hyperreactive to pain and to psychological stress.     

Perception of triggers in young nonclinical school students with migrainous headaches and with tension headaches.

In an exploratory study of a general population of 209 young children (M = 12.9 yr. old), 59% of those with migraine or tension headache (n = 41) reported one or more triggers. More triggers were reported from those with tension headaches than from those with migrainous headaches.     

Interaction Analysis and Psychology: A Dialogical Perspective

Interaction analysis is not a prerogative of any discipline in social sciences. It has its own history within each disciplinary field and is related to specific research objects. From the standpoint of psychology, this article first draws upon a distinction between factorial and dialogical conceptions of interaction. It then briefly presents the basis of a dialogical approach in psychology and focuses upon four basic assumptions. Each of them is examined on a theoretical and on a methodological level with a leading question: to what extent is it possible to develop analytical tools that are fully coherent with dialogical assumptions? The conclusion stresses the difficulty of developing methodological tools that are fully consistent with dialogical assumptions and argues that there is an unavoidable tension between accounting for the complexity of an interaction and using methodological tools which necessarily “monologise” this complexity.     

Electrode placement,EMG feedback,and relaxation for tension headaches

Fifteen tension headache subjects were allocated to one of three groups: direct EMG feedback (from a site corresponding to the source of pain), indirect EMG feedback (from a site not corresponding to the source of the pain) and relaxation instructions. There were two base-line, six treatment and one post-treatment sessions. No significant differences were found between base-line and post-treatment EMG levels, for any of the groups; however, some significant reductions in levels were obtained within sessions. EMG levels recorded during headache attacks did not differ significantly from levels recorded during base-line. Frequency and intensity of headaches were significantly reduced, particularly in the relaxation group. At follow-up this improvement was maintained for subjects with forehead pain, but differences between the groups had disappeared.     

Perceptual Indiscriminability: In Defence of Wright's Proof

A series of unnoticeably small changes in an observable property may add up to a noticeable change. Crispin Wright has used this fact to prove that perceptual indiscriminability is a non-transitive relation. Delia Graff has recently argued that there is a 'tension' between Wright's assumptions. But Graff has misunderstood one of these, that 'phenomenal continua' are possible; and the other, that our powers of discrimination are finite, is sound. If the first assumption is properly understood, it is not in tension with but is actually implied by the second, given a plausible physical assumption.     

Medlemsaktivitet i BTF

Abstract

EMG-biofeedback assisted relaxation training was used in the treatment of tension headache. Two groups of subjects were treated with either a “standard biofeedback” method, or a “biofeedback with generalization training” method. The latter included procedures which were aimed at maximizing voluntary control of frontal muscle activity in the absence of external feedback, as well as the ability to use the self-regulation skills in every-day life. The results indicated that only the “standard biofeedback” group showed evidence of increased relaxation abilities. However, these greater achievements were not accompanied by comparable superiority regarding headache decreases. These results are discussed and some hypothetical explanations are put forward.     

Frege and propositional unity

This paper identifies a tension in Frege’s philosophy and offers a diagnosis of its origins. Frege’s Context Principle can be used to dissolve the problem of propositional unity. However, Frege’s official response to the problem does not invoke the Context Principle, but the distinction between ‘saturated’ and ‘unsaturated’ propositional constituents. I argue that such a response involves assumptions that clash with the Context Principle. I suggest, however, that this tension is not generated by deep-seated philosophical commitments, but by Frege’s occasional attempt to take a dubious shortcut in the justification of his conception of propositional structure.     

On Following Commands: A Philosophical Inquiry Into the Governing Values of Swedish Early Childhood Education

In this article I will investigate a perceived tension in Swedish early childhood education (ECE) policy between reevaluating certain foundational claims on the one hand and following universal moral commands on the other. I ask the question; how is it that certain commonly held assumptions are being debunked and others left undisturbed in this particular context? To this end, I look at some of the preconditions of framing the educational practice by universal moral commands so as to make visible some of its underlying ontological assumptions. Correspondingly, I look at some necessary epistemological and ontological prerequisites for understanding knowledge formation as essentially relational, such as it is construed in the policy documents concerned. I connect this with a broader trend in educational philosophy and theory, one where the destabilizing of a Cartesian notion of subjectivity has opened up for more relational conceptions of subjectivity. Next, I will take a closer look at some key passages from the policy documents where the appeal to moral universalism runs parallel with an appeal to a relational ontology. Having done so, I point to some epistemological problems with combining these two conflicting approaches on a policy level. To conclude, I formulate some final thoughts regarding how one might begin to resolve this tension within the discourse of Swedish ECE by coming to terms with what kind of ontological and epistemological foundation to rely upon. I do this by trying out the notion of a pedagogy of dosage.     

Memory of pain and affect associated with migraine and non-migraine headaches

The main aims of this study were to assess memory of pain and pain-related affect in headache sufferers and to compare the pain memories of individuals who suffer from migraines and those who experience non-migraine headaches. A total of 313 women participated in the study, 86 of whom had a diagnosis of migraine headache. The women rated their state anxiety about having a headache, the intensity and unpleasantness of headache pain, and their emotions while actually experiencing a headache. Either three or six months later, the participants were asked to recall their state anxiety, the intensity and unpleasantness of pain, and the emotions they had felt. Regardless of the length of recall delay or migraine diagnosis, participants accurately remembered both pain intensity and unpleasantness. Together, recalled anxiety, experienced pain and recalled positive affect were the most important predictors of memories for headache, accounting for 41% and 37% of the total variance in recalled pain intensity and unpleasantness, respectively. However, participants overestimated recalled positive and negative affect. The effect of recalled affect on memory of headache, together with the overestimation of recalled affect, suggests that although memory of headache is accurate, it is influenced by distorted memories of affect.