PerceptuaiandMoior Skillr, 1992, 7 5 , 284-286. O Perceptual and Motor Skills 1992
PERCEPTION OF TRIGGERS IN YOUNG NONCLINICAL S C H O O L STUDENTS W I T H MIGRAINOUS HEADACHES A N D WITH TENSION HEADACHES ' S. OSTERHAUS
AND
J. PASSCHIER Department of Medical Psychology and Psychotherapy Erasmus University, Rotterdnm
Department of Psychophysiology Vrije Universiteit, Amsterdam
Summary.-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.
Identifying the trigger mechanisms for headaches is expected to give an important clue to the most adequate medical or psychological treatment. Many adult sufferers from chronic headaches, however, are unable to report any specific triggers for their headaches (Arena, Blanchard, & Andrasik, 1984). Similarly, in a study of school students with headaches, 60% of them could not specify any trigger mechanism (Passchier & Orlebeke, 1985). In this exploratory study the relationship between positive trigger reports and headache type was investigated in a young population.
METHOD The study was part of a larger project on the effects of Progressive Relaxation Training on stress and headaches among school children. A population of school students (n =209), including both boys and girls, whose mean age was 12.9 yr. and whose ages ranged from 12 to 15 years old, were invited to complete an adapted version of Waters' Headache Questionnaire (Waters, 1973). They were asked to keep a headache diary in which, four times a day for three weeks, the presence and the triggers of all headaches were to be recorded. From this sample, a group with migrainous headaches (n = 18, 7 boys and 11 girls) and another group with tension headaches (n = 23, 10 boys and 13 girls) were selected on the basis of their answers given on the questionnaire and the criteria outlined by Vahlquist (1955). A check showed there were no significant differences between the groups regarding sex or average headache activity measured as frequency, duration, and intensity of their headaches. Differences between the number of triggers reported by the students were tested using a XZ test for independent samples.
'Address correspondence to S. 0 . L. Osrerhaus, Vrije Universiteit, Department of Psychophysiology, D e Boelelaan 1111-1115, 1081 HVAmsterdam, The Netherlands.
285
PERCEPTIONS O F TRIGGERS FOR HEADACHES
RESULTS The number and nature of the triggers reported are presented in Table 1. Only 59% of our young nonclinical sample reported one or more triggers, which is consistent with previous findings (Arena, et al., 1984; Passchier & Orlebeke, 1985). The students with tension headaches reported a trigger = 6.65, p < more often than did students with migrainous headaches 0.01). TABLE 1
TIUGGER REI~ORTIN TENSION A N D MIGRAINOUS HEADACHE GROUPS: NUMBER, PERCENT, NATURE Trigger Report
Tension Headache n
Vo
Present 18 78.3 5 21.7 Absent Specific Triggers* Physical 26 16 Stress 1 Temperature 0 ~ood "Some students mentioned more than one trigger.
Migrainous Headache n Yo 6 12
33.3 66.7
9 3 2 1
The finding of more frequent trigger reports among sufferers from tension headaches than from migrainous headaches cannot be due to response bias, because the migrainous group showed a greater tendency to report prodromal symptoms = 2.75, p = 0.11). Possibly the variety of trigger factors for migrainous headaches is larger than for tension headaches, which makes it difficult for the sufferer to discover a systematic relationship. Or, young persons with migraine headaches might show more repression of emotional triggers, which may be reflected by the relatively few stress triggers mentioned by this group (see Table 1). Repression has previously been reported as observed more often for migrainous young women than for their controls (Passchier, Goudswaard, Orlebeke, & Verhage, 1988). Another possible explanation for the significant difference in trigger-mentioning between the rnigraine and the tension headache groups is based on the hypothesis of a longer lag occurring between trigger and onset of the headache in migraine than in tension headache. This would make the identification of triggers more difficult for the migraine patients than for the tension headache sufferers. Research into the reporting of headache triggers, in which personality variables and amnestic information are also included, can probably supply further information on the observed phenomenon. REFERENCES
ARENA, J. G., BLANCHARD, E. B., & ANDRASIK,F. (1984) The role of affect in the etiology of chronic headache. Journal of Psychosomatic Research, 28, 79-86.
286
S. OSTERHAUS & J. PASSCHIER
{.
PASSCHIER, J., GOUDSWAARD, P., ORLEEEKE. F , &,VERI-IAGE, F. (1988) Migraine and defense mechanisms: psychophysiological re a t ~ o n s h l ~Ins young females. Social Science and Medicine, 26, 343-350. PASSCIIIER,J., & ORLEBEKE, J. F. 11985) Headaches and stress in school children: an epidemiological study. Cephahlgia, 5, 167-176. VA~ILQUIST, B. (1955) Migraine in children. International Archives for Allergy, 7 , 348-355. WATERS,W. E. (1973) The epidemiology of migraine. Infernational Journal o/ Epidemiology, 2 , 187-194.
Accepted lune 29, 1992.
PERCEPTION OF TRIGGERS IN YOUNG NONCLINICAL S C H O O L STUDENTS W I T H MIGRAINOUS HEADACHES A N D WITH TENSION HEADACHES ' S. OSTERHAUS
AND
J. PASSCHIER Department of Medical Psychology and Psychotherapy Erasmus University, Rotterdnm
Department of Psychophysiology Vrije Universiteit, Amsterdam
Summary.-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.
Identifying the trigger mechanisms for headaches is expected to give an important clue to the most adequate medical or psychological treatment. Many adult sufferers from chronic headaches, however, are unable to report any specific triggers for their headaches (Arena, Blanchard, & Andrasik, 1984). Similarly, in a study of school students with headaches, 60% of them could not specify any trigger mechanism (Passchier & Orlebeke, 1985). In this exploratory study the relationship between positive trigger reports and headache type was investigated in a young population.
METHOD The study was part of a larger project on the effects of Progressive Relaxation Training on stress and headaches among school children. A population of school students (n =209), including both boys and girls, whose mean age was 12.9 yr. and whose ages ranged from 12 to 15 years old, were invited to complete an adapted version of Waters' Headache Questionnaire (Waters, 1973). They were asked to keep a headache diary in which, four times a day for three weeks, the presence and the triggers of all headaches were to be recorded. From this sample, a group with migrainous headaches (n = 18, 7 boys and 11 girls) and another group with tension headaches (n = 23, 10 boys and 13 girls) were selected on the basis of their answers given on the questionnaire and the criteria outlined by Vahlquist (1955). A check showed there were no significant differences between the groups regarding sex or average headache activity measured as frequency, duration, and intensity of their headaches. Differences between the number of triggers reported by the students were tested using a XZ test for independent samples.
'Address correspondence to S. 0 . L. Osrerhaus, Vrije Universiteit, Department of Psychophysiology, D e Boelelaan 1111-1115, 1081 HVAmsterdam, The Netherlands.
285
PERCEPTIONS O F TRIGGERS FOR HEADACHES
RESULTS The number and nature of the triggers reported are presented in Table 1. Only 59% of our young nonclinical sample reported one or more triggers, which is consistent with previous findings (Arena, et al., 1984; Passchier & Orlebeke, 1985). The students with tension headaches reported a trigger = 6.65, p < more often than did students with migrainous headaches 0.01). TABLE 1
TIUGGER REI~ORTIN TENSION A N D MIGRAINOUS HEADACHE GROUPS: NUMBER, PERCENT, NATURE Trigger Report
Tension Headache n
Vo
Present 18 78.3 5 21.7 Absent Specific Triggers* Physical 26 16 Stress 1 Temperature 0 ~ood "Some students mentioned more than one trigger.
Migrainous Headache n Yo 6 12
33.3 66.7
9 3 2 1
The finding of more frequent trigger reports among sufferers from tension headaches than from migrainous headaches cannot be due to response bias, because the migrainous group showed a greater tendency to report prodromal symptoms = 2.75, p = 0.11). Possibly the variety of trigger factors for migrainous headaches is larger than for tension headaches, which makes it difficult for the sufferer to discover a systematic relationship. Or, young persons with migraine headaches might show more repression of emotional triggers, which may be reflected by the relatively few stress triggers mentioned by this group (see Table 1). Repression has previously been reported as observed more often for migrainous young women than for their controls (Passchier, Goudswaard, Orlebeke, & Verhage, 1988). Another possible explanation for the significant difference in trigger-mentioning between the rnigraine and the tension headache groups is based on the hypothesis of a longer lag occurring between trigger and onset of the headache in migraine than in tension headache. This would make the identification of triggers more difficult for the migraine patients than for the tension headache sufferers. Research into the reporting of headache triggers, in which personality variables and amnestic information are also included, can probably supply further information on the observed phenomenon. REFERENCES
ARENA, J. G., BLANCHARD, E. B., & ANDRASIK,F. (1984) The role of affect in the etiology of chronic headache. Journal of Psychosomatic Research, 28, 79-86.
286
S. OSTERHAUS & J. PASSCHIER
{.
PASSCHIER, J., GOUDSWAARD, P., ORLEEEKE. F , &,VERI-IAGE, F. (1988) Migraine and defense mechanisms: psychophysiological re a t ~ o n s h l ~Ins young females. Social Science and Medicine, 26, 343-350. PASSCIIIER,J., & ORLEBEKE, J. F. 11985) Headaches and stress in school children: an epidemiological study. Cephahlgia, 5, 167-176. VA~ILQUIST, B. (1955) Migraine in children. International Archives for Allergy, 7 , 348-355. WATERS,W. E. (1973) The epidemiology of migraine. Infernational Journal o/ Epidemiology, 2 , 187-194.
Accepted lune 29, 1992.
