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HEADACHE PRECIPITANTS AND PAIN BEHAVIORS
J.P. Davig, MS, Univ of Miss Medical Center, Jackson, focused on behaviors related to recurrent migraine and tension-type headaches. Specific patient behaviors included retreat, display, and resting. Significant others' responses to the patients' behavior consisted of helping, ignoring or avoiding, and expressing anger. Patients showed more likelihood of resting or retreating than drawing attention or asking for help. Significant others often offered help and rarely became angry or ignored the patient.

Patient demography Fifty-six consecutive patients at the University Head Pain Center participated. The 50 females and 6 males, mainly white (42/56), ranged in age from 15 to 72 years (mean,40). Patients satisfied the diagnostic criteria of the International Headache Society for grouping as migraine (68%) and tension-type (32%). The median headache duration was 14.9 years with a frequency of 21.8 d/mo and the intensity was 7.6 on a scale of 0 (none) to 10 (extremely painful).
Self-reported headache precipitants Environmental factors brought about a migraine headache more often than a tension-type (p=0.02). Glare, strong odors/smoke, and weather or temperature changes were mentioned frequently. Equally important as headache precipitants for both groups were diet, adverse behavior, and hormonal fluctuation.
Self-reported headache behaviors Davig measured three behavioral responses in the study. These were (1) retreat - minimizing physical activity or avoiding stimulation from the environment, (2) display - calling attention to oneself or soliciting assistance, and (3) rest - lying down, relaxing, or sleeping. Migraineurs sought attention or solicited assistance (display) more often than tension-type headache patients (p=0.03). Rest and retreat behaviors occurred more frequently than display in both patient types (p<0.01).
Self-reported significant others' behaviors The responses fell into three groups. These were (1) help - expression of concern or an offer of assistance, (2) ignore - disregard or avoid patient, and (3) anger - express irateness for patient's situation. According to the patients, others most often expressed helpfulness and rarely showed anger or ignored their headache (p<0.001).
Migraine vs tension-type headache behaviors The behavior called rest was similar in both headache groups according to self-assesment scores. Migraineurs showed more of a tendency for retreat and display behaviors (p=0.06 and p=0.03, respectively). The headache groups did not differ appreciably in interpreting significant others' behaviors of helping, ignoring, or becoming angry.
Headache frequency, severity and behavior Regardless of diagnosis, patient behaviors of rest or retreat correlated significantly with headache frequency (p<0.01) and intensity (p<0.05). Neither frequency of patient headache nor severity correlated with any of the significant others' behaviors.
For professional correspondence, please contact Jim Davig and Dr. Penzien at: jdavig@worldnet.att.net and penz@fiona.umsmed.edu, respectively.

Eugene A. Conrad

Presented at Thirty-ninth Annual Scientific Meeting, American Association for the Study of Headache (AASH), June 19-22, 1997
Copyright © 1997 Conrad Group, Inc. All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078-2230 / September 1997

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