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How does stress induce headache? An experimental study

Miller Berry, Juanita K. (2020) How does stress induce headache? An experimental study. Professional Doctorate thesis, Murdoch University.

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Psychological stress triggers headaches, but how this happens is unclear. To explore this, 38 episodic migraine sufferers, 28 with tension-type headache (T-TH) and 20 controls rated nausea, negative affect, task-expectancies and headache at 5-minute intervals during an unpredictable and uncontrollable 25-minute mental arithmetic task with a non-contingent failure rate. Blood pressure and pulse rate were measured every 3 minutes and salivary cortisol was sampled before and after the task. Trigeminal activation was measured by nociceptive blink reflex measures during each of the three experimental phases.

Multiple regression analyses indicated that negative affect (NA) was the strongest predictor of headache intensity during the task. Increases in stress-headache were unrelated to consistent changes in cardiovascular activity but were related to declines in cortisol and increased post-task trigeminal activity. In repeated measures ANOVAs, participants who developed headache had higher nausea, NA and self-efficacy expectancies than those with no-or-low headache (p <.05 to p <.001). In further multiple regression analyses to identify which aspects of the stress process contributed to the high NA preceding headache, discouragement, anxiety, irritation and tension mediated the relationship between headache intensity during the stressful task and primary and secondary appraisal processes (stressor exposure and stressor reactivity). Avoidant coping, perceived inability to decrease pain, and outcome expectancy independently predicted headache intensity during the stressful task. Anxiety mediated the relationship between headache intensity and the coping tactics of wishful thinking, self-criticism, pain catastrophizing and praying/hoping. Attachment anxiety and the personality traits of openness, agreeableness and conscientiousness moderated the relationship between stress appraisals and headache. Results were discussed using the model of stress-headache as allostatic load.

Findings suggest that headache developed when participants overextended themselves during a stressful task, adopting an information processing style which impeded emotional adjustment to changing situational demands. Learning to modify perceptions of threat and adopting a more flexible, less outcome-dependent processing style which avoids response conflict might help to prevent headache from spiralling upward.

Item Type: Thesis (Professional Doctorate)
Murdoch Affiliation(s): Psychology, Counselling, Exercise Science and Chiropractic
United Nations SDGs: Goal 3: Good Health and Well-Being
Supervisor(s): Drummond, Peter
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