Headaches are a common problem, and psychological factors are widely acknowledged as playing a critical role in the development and maintenance of a high proportion of cases. This mini series consists of six contributions to the headache literature from researchers working in Australia. The papers focus on cycles in headache activity; behavioural patterns, copying styles and personality characteristics of headache sufferers; psychophysiological pain mechanisms; and potential adverse consequences of simplistic treatment approaches. The emphasis on non-treatment studies is unusual in this field but argued to be appropriate in view of the lack of knowledge concerning basic headache processes.

Individual case histories collected variously in Europe and in Australia, recorded over long unbroken sequences, on a daily self-report basis, are potentially analysable as time series. The assessment of spontaneous changes in the dynamics of headache generation and attenuation, and the consequences, if any, of superimposed therapeutic intervention, require that we treat the self-report ratings of headache intensity and duration as a multistate process which is highly autoregressive. Some strong insights into individual differences both in chronic headache patterns, and in response to treatment, are obtained. Of particular interest are individual differences in cyclical and quasi-periodic headaches and in the possible causality of such differences.

Tension (muscle contraction) headache is often associated with high task demands, and relaxation is frequently recommended during daily work activities in many treatment programs. The effect of relaxation on concurrent task performance is assumed to be beneficial, or at worst to have no effect, but this assumption is seldom made explicit. This paper presents results from two experiments which have examined the effects of muscle tension and relaxation on concurrent task performance, in headache-prone and non-headache groups. Results indicated that induced frontalis relaxation did not generally result in optimal task performance; the performance measure affected (accuracy or reaction time) was related to the type of task being performed. Differences between the headache and non-headache subjects were especially related to interactions between task difficulty level and “optimal” level of frontalis tension. Further research is needed to clarify the aspects of performance most affected by variations in frontalis tension and the appropriateness of attempting to relax the frontalis muscle in task situations.

The view that dilatation of scalp arteries is a major source of pain in migraine was examined in a series of clinical and psychophysiological investigations. Examination of patients during unilateral migraine or tension-vascular headache demonstrated evidence of extracranial vasodilatation in only a minority of patients. Studies of psychophysiological reactivity indicated that the amplitude of superficial temporal artery pulsations increased more on the side habitually affected by headache than on the non-symptomatic side after light exercise, and increased more readily in migrainous subjects than in non-headache controls during psychological stress. In patients who had previously shown thermographic signs of an increase in blood flow at the site of headache, scalp arteries dilated readily to mental arithmetic stress and exercise. Although extracranial vasodilatation sometimes contributes to migraine, it does not appear to be the primary source of pain in the majority of patients. Regulation of scalp artery diameter may be most effective in the subgroup of patients whose scalp arteries contribute to pain.

This study is concerned with the coping strategies and personality characteristics of headache sufferers. Comparisons were made between headache patients, tinnitus patients and normal controls (N = 105) on the Neuroticism subscale of the Eysenck Personality Questionnaire (EPQ), Taylor Manifest Anxiety Scale (MAS), Beck Depression Inventory (BDI), Unpleasant Events Schedule (UES), a measure of emotional control and a measure of cognitive appraisal of stressors. Statistical analyses revealed that headache sufferers scored in the more pathological direction than the controls on the EPQ, MAS and the measure of cognitive appraisal of stressors. Tinnitus patients did not differ from normal controls on these measures. These results are compared with those of other studies of the personality characteristics and psychological features of headache sufferers. Implications for further research in this area, and for the treatment of headaches, are discussed.

This article describes three studies that explore the relationship between headaches and the Type A behaviour pattern. The results of the first study demonstrated that in a student sample individuals who suffer from more fequent headaches and headaches of higher intensity have significantly elevated Type A scores. The second study complemented the first by showing that the majority of chronic headache sufferers displayed the Type A behaviour pattern; and the findings of the two studies together suggested that between 68% and 90% of chronic headache sufferers may be classified as Type A's. The results of the third study indicated that individuals whose headaches tended to be associated with negative affect (depression, anxiety, hostility, tiredness, confusion and unsureness) had significantly higher Type A scores than individuals whose headaches tended not to be associated with negative affect. It was suggested that the Type A behaviour pattern is a risk factor for headaches (as well as coronary heart disease and other disorders) as it resulted in the frequent experience of stress and negative affect which in turn could lead to headaches. Also, Type A individuals probably responded to headaches with more distress than those not exhibiting this behavioural style so that they were more likely to become trapped in the stress-headache spiral.