Study on Effect of Stress In Migraine: Effect of Psychological Intervention

Headache is the most common complaints for which people see neurologists and physicians and it is the seventh most common reason they visit their primary care doctors. It has troubled mankind from the dawn of civilization. It is one of the most common symptoms in mankind. It is the third most common cause of missed work and it affects every area of a person’s life. Many people who suffer from headaches either treat themselves or attempt to ignore their headaches. Headaches have an extraordinary impact and can seriously undermine the quality of life. For most of us, it is an infrequent and relatively minor inconvenience but for a substantial minority, recurrent or persistent headache is a serious disability and handicap. Some significant consequences occur for the wider community in terms of time lost from work and treatment costs due to headache. The headache disorder is mainly classified in two types- (i) primary headache disorders and (ii) secondary headache disorder. Primary headache disorders are again classified as migraine headache, tension-type headache and cluster headache. Migraine is a painful neurological condition and its symptoms are intense, throbbing and disabling episodic pain. Migraine headaches are usually characterized by severe pain on one or both sides of the head and the pain usually last from 4 to 72 hours duration and are often accompanied by hypersensitivity to light and sound and feelings of nausea. It is a condition that has always plagued the human race.

Migraine is one of the most prevalent disorders seen in clinical practice today, affecting nearly 28 million people in American country. It is also a major cause of disability in the workplace and it leads to indirect costs to society greater than 13 billion dollars a year. The prevalence of migraine is highest during the years of peak productivity, i.e., between the ages of 25 and 55 years (Nissan and Diamond, 2005). European and American studies indicate that 6-8% of men and 15-18% of women experience migraine each year (Blanda and Wright, 2006). It is less prevalent but still common in Asia (3% of men and 10% of women) (Scher, 1999). Thus from all this discussion we can realize that migraine is a major problem and it affects people in every walk of their life. Several kind of physiological or neurological causes play an important role in migraine. But there

Design:

A sample of 200 participants (male = 108 and female = 92) was selected for the present study. All the participants were diagnosed migraine patients. The sample was selected from the civil and private hospitals/clinics of Rohtak, Bhiwani, Hisar and Sirsa districts of Haryana. For the second phase of the study 60 patients were randomly assigned in three groups. Only those patients having at least two attacks in a fortnight period and scored three or more on a five point scale of perceived intensity of pain were selected for the intervention part of the study. All these 60 patients were randomly selected for the psychological intervention. Here, 20 patients were given Relaxation training alternatively for fifteen days and 20 patients were given EMG-biofeedback therapy in the same way. One control group of 20 patients was also selected to which no psychological intervention was given. All these 60 patients were taking medications

4. State-Trait Anger Expression Inventory-2 (Spielberger, 1988). 5. Presumptive Stressful life Events Scale (PSLE Scale) (Singh, Kaur and Kaur, 1983). 6. Perceived intensity of migraine pain and frequency of migraine attack scale. The obtained data were analyzed by employing measures of central tendency and variability as descriptive statistics. Pearson coefficients of correlation and stepwise multiple regressions were also calculated. For the effect of psychological intervention, ANOVA suitable for multi-group designs with Duncan’s post-hoc test was used. Paired sample t-test was also used for comparing the baseline scores on perceived intensity of pain and frequency of migraine attack and the retest scores after intervention in the form of JPMR, EMG-biofeedback and control group.

• Females were found to have higher level of suppression of outward expression of anger i.e. anger-in than males as well as total anger expression. Male and female migraine patients were almost equal in case of outward expression of anger (anger-out) and control of outward expression of anger (anger-con).

 In case of total sample the results of anger expression indicated that total anger expression, suppression of outward expression of anger (anger-in) and outward expression of anger (anger-out) were significantly and positively correlated with perceived intensity of migraine pain. As far as perceived frequency is concerned total anger expression, suppression of outward expression of anger (anger-in) and outward expression of (anger-out) were also significantly and positively correlated with perceived frequency of migraine attack. However, control of outward expression of anger (anger-con) was not significantly and positively correlated with either perceived intensity of pain or perceived frequency of migraine attack. Rather it was negatively correlated with perceived intensity and frequency of migraine attack.

positively and significantly correlated with perceived intensity of migraine pain. However, control of outward expression of anger was not found to be correlated with perceived intensity of migraine. Similarly as far as perceived frequency of migraine attack is concerned total anger expression, suppression of outward expression of anger and outward expression of anger were not positively and significantly correlated with perceived frequency of migraine attack in males.

• In case of females outward expression of stress was found to be positively and significantly correlated with perceived intensity of migraine pain in females. However, total anger expression and suppression of outward expression of anger were not found to be correlated with perceived intensity of migraine pain. As far as perceived frequency of migraine attack is concerned, total anger expression, Suppression of outward expression of anger (anger-in) and outward expression of anger correlated significantly and positively with perceived frequency of migraine attack. Here, also control of outward expression of anger was not found to be correlated with perceived frequency of migraine attack.

• Psychological intervention in the form of relaxation training and EMG-biofeedback found to be significantly and positively effective in migraine. However, no difference was found in the effectiveness of relaxation training and EMG-biofeedback training.

REFERENCES

• Abu-Arafeh, I. and Russel, G. (1995). Prevalence and clinical features of abdominal migraine compared with those of migraine headache. Archives Distribution Child, 72, 413-417.

• Abu-Arefeh, L., and Russell, G. (1994). Prevalence of headache and migraine in schoolchildren. British Medical Journal, 309, 765-769.

• Alexander, F.G. and French, T.M. (Eds.). (1948). Studies in psychosomatic medicine: An approach to the cause and treatment of vegetative disturbance, New York: Ronald.

• Averill, J.R. (1983). Studies on anger and aggression. American Psychologist, 38, 1145-1159.

• Bag, B. R., Hacihasanoglu, R. and Tufekci F. G. (2005). Examination of anxiety, hostility and psychiatric disorders in patients with migraine. International Journal of Clinical Practice, 59, 515.

• Barbara, Grothgar, O. and Berndt, Scholz .(1987). On Specific Behavior of Migraine Patients in an Anger-Provoking Situation. Headache. The Journal of Head and Face Pain, 27, 206-210.

• Cepeda, M.S. and Carr, D.B. (2003). Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesthesia Analogy, 97,1464-1468.

• Davies, P. and Windle, M. (1997). Gender-specific pathways between maternal depressive symptoms, family discord, and adolescent adjustment. Developmental Psychology, 33, 657-668.

• Ellermeier, W., Westphal, W. (1995). Gender differences in pain ratings and pupil reactions to painful pressure stimuli. Pain, 61, 435-439.

• Endler, N. S. and Okada, M. (1975). A multidimensional measure of trait anxiety: The s-r inventory of general trait anxiousness. Journal of Consulting and Clinical Psychology, 43, 319-329.

• Goleman, D. (1987), The Mind over the Body,New York Times.

• Goleman, D. and Gurin, J. (1993). Mind-body medicine: How to use your mind for better health. Yonkers, NY: Consumers Union of United States, Inc.Web Page: (http://www.thefreelibrary.com/Access+to+biofeedback+therapy+for+wsomen+suffering+from+headache+in...-a0174057634 as on 24/12/10)

• Holmes, T.H. and Rahe, R.H. (1967). The Social Readjustment Rating Scale. Journal of Psychosom Res. 11, 213-218.

Holroyd, K. A., Penzien, D. B., Hursey, K. G., Tobin, D. L., Rogers, L., Holm, J. E. and Marcile, P. J. (1984). Change mechanisms in EMG biofeedback training: Cognitive changes underlying improvements in tension Headache. Journal of Consulting and Clinical Psychology, 52, 1039-1053.

• Humphrey, P.P., Feniuk, W. and Marriott, A.S. et al (1991). Preclinical studies on the anti-migraine drug, Sumatriptan. Europeon Neurology, 31, 282-290.

 Jacobson E. (1929). Progressive Relaxation: A Physiological and Clinical Investigation of Muscular States and Their Significance in Psychology and

• John, B., Stanley, k. and Leo, R. (1971). Psychological factors in headache. The Journal of head and Face Pain, 11, 117.

• Kabela, E., Blanchard, E.B. and Applebaum, K.A. (1989). Self-regulatory treatment of headache in the elderly: Biofeedback and Self-Regulation. Medline, 14, 219-228.

• Lake. A., Rainey J. and Papsdorf, J.D., (1979). Biofeedback and Rational-emotive therapy in the management of migraine headache. Jounral of Applied Behaviour Analogy, 12,127-140.

• Lance, J.W. (1976). Headaches related to sexual activity. Journal of Neurol, Neurosurgry and Psychiatrist, 39, 226-1230.

• Lance, J.W. (1982). Mechanisms and Management of Headache, 4th edn. London: Butterworth Scientific, 1-6.

• Murray, H. (1938). Explorations in personality, Oxford University Press, New York.

 Nasby, W., Hayden, B. and DePaulo, B. M. (1980). Attributional bias among aggressive boys to interpret unambiguous social stimuli as displays of hostility. Journal of Abnormal Psychology, 89, 459-468.