Whether tension headache or migraine, there is scientific evidence to suggest that vascular processes are operative in tension, as well as in migraine (Ostfeld, Reis & Wolff, 1957; Tunis & Wolff, 1954). Thus, muscle contraction may be a consequence rather than a cause of tension headache, and the two disorders may be "quantitatively different clinical manifestations of vasomotor instability" (Raskin & Appenzeller, 1980, p.174).

Stress and headache

Tension headache:

It is generally accepted that tension headache occurs in conjunction with the stresses of life. However, descriptions of the types of stress that most frequently precipitate or aggravate the symptoms of tension headache are rare. In a sample of 72 non-migraineurs (apparently presenting with symptoms of tension headache), Howarth (1965) found an obvious association between stressful life events and headaches in 54% of the sample. For the most part, the headaches did not seem to be caused by dramatic life events, but by everyday stresses, work, family, environment, climate, diet, etc.… but personally significant that can occur chronically. For example, in 27.7% of the cases, the headache seemed to be precipitated by domestic or social problems and in 19.4%, by work problems, stressful events. There is a surprising tendency for migraine symptoms not to appear at the peak of stress, but during a period of relaxation immediately following the stress, for example at the end of the school year for teachers. Also, not directly related to stress, include triggers such as diet (particularly items containing nitrate, glutamate, tyramine or salt) and processed foods, oral contraceptives, physical exertion, menstruation, alcohol consumption and excessive glare from the light.

Relaxation and biofeedback

For the past 10 years, biofeedback and relaxation training has been widely used in the treatment of tension and migraine headaches.

Existing evidence indicates that relaxation training, EMG biofeedback. The frontal electromyographic biofeedback (EMG) used alone or as a facilitator of muscle relaxation, continues to be, despite the controversies that have arisen over the years (8), one of the recommended strategies for the specific treatment of headache tensional.

Autogenic training (relaxation method) and various combinations of these interventions also appear to be effective in reducing migraine symptoms, with 40% to 80% of clients showing at least moderate improvement after treatment.

Elsewhere (eg, Holroyd, 1979), we have suggested that biofeedback and relaxation therapies may be effective because they indirectly induce patients to alter their transactions with the environment, not because they allow them to directly control problematic physiological responses.

Sometimes situations that cause headaches and it is possible to learn to manage them by restructuring the environment to reduce the threats of loss of control, changing the meaning that the person attributes to potentially stressful situations and / or reducing the intensity of physical activity and emotional disorder that characterizes the experience of stress.

A second point of intervention is to try to change the individual's perception of threat in situations that imply loss of control.

Most of the threats and challenges we face are not in the form of a great tragedy, but rather a little irritation. He's the obnoxious son at the breakfast table, the stoplight not turning green, the work project stuck in a series of repetitive committee meetings, the co-worker who doesn't listen, etc. stress on the human system. But while the person cannot control, except to a limited degree, the demands, challenges, and threats that affect their daily life, they can play an active role in determining the impact of a potential stressor and shaping the course. from an episode of stress.

In contrast to this automatic and stereotyped response pattern, the individual is aware of his thoughts, feelings, and physical and behavioral reactions and exercises active control over them. The competent person is no more capable than the handicapped of avoiding potentially stressful situations altogether, but his mental preparation for the possibility, his differentiated appraisals of events (internal and external) and his wide repertoire of police techniques allow him to respond in a that maximizes impact and minimizes stress. The skilled therapist continually emphasizes that the ability to keep emotions in check will allow the person to take more effective actions. The reduction of negative emotions and knowing how to use emotional facilitators such as humor, resilience, creativity, optimism, etc ... can gradually transform an altered state, be it a migraine or another ailment, into a state of well-being. As the weeks have passed by practicing emotional facilitators, it has been found that groups of people suffering from migraines managed to mitigate the full force of the emotional storm and sometimes even stop it altogether.

Treatment content (scientific works carried out in groups of people with migraine)

The coping techniques chosen for this program were muscle relaxation (Bernstein and Borkovec, 1973), rational-emotional thinking (RET; Ellis and Grieger, 1977; Maultsby and Ellis, 1978), training in communication skills (Stuart, 1974). ), problem solving (D'Zurilla & Goldfried, 1971) and, in a special role, an adaptation of stress inoculation (Meichenbaum, 1977).

Clients reported that they rationally reassessed headache-related stress, behaved more assertively, avoided stressful situations, and many other changes in their responses to situations that had previously triggered headaches. These changes in coping rather than the learned control of EMG activity may, therefore, have mediated improvements in headache symptoms. It can be speculated that (1) the greater awareness of the muscle pattern of the results was still evident at three years of follow-up (Andrasik and Holroyd, 1982) and the same results with daily relaxation practices, introducing relaxation into our day-to-day life .


Thus, treatment could productively focus not only on physiological responses to stress, but also on the cognitive and behavioral variables that influence these stress responses. Second, biofeedback and relaxation training provides clients with a unique coping response (relaxation), while the complex demands of daily life often require flexible coping skills.

Cognitive-behavioral treatment can be roughly divided into three phases: education, self-management, and training in problem solving or coping skills. Before initiating treatment, clients are instructed to record the occurrence of headaches and rate the severity of the headache throughout the day. This can be done on a pocket card that also provides space to record headache management efforts (both medication use and psychological coping strategies) and circumstances surrounding the headache.

The educational phase has four objectives: to educate the client about the pathophysiology and triggers of the headache, to explain the treatment process, to combat the demoralization and depression that often characterize chronic headache sufferers, and to convey to clients that they are expected to take an active role in managing their symptoms.

Because headache sufferers often attribute their symptoms to overwhelming external pressures or global personal inadequacies, the task of the therapist is to convincingly present an alternative framework that emphasizes headache triggers that are potentially under the control of the headache. client. The therapist and client discuss in detail both the ways in which stress can precipitate a headache and the ways in which cognitive processes shape responses to stress. Written materials, teaching examples, and the therapist's personal experiences are used to illustrate how psychological processes can influence responses to stress and thus headache symptoms.


Once the treatment process has been explained, clients are taught to monitor their responses to stress in their lives. The goal is to enable clients to identify overt and covert event patterns that precede the headache. In our experience, the most effective therapists obtain finely detailed accounts of the client's response to stress, rather than comprehensive retrospective reports. Therefore, we encourage clients to record their feelings, thoughts, and behaviors before, during, and after stressful events so that they do not have to rely on their memory during treatment sessions. Detailed information is also gained by having clients imagine stressful situations they have identified, reporting their perceptions and experiences in the form of a stream of consciousness. As the client becomes more familiar with this self-control, the therapist helps him to identify the relationships between situational variables (eg, criticism of the spouse); thoughts (eg, "I can't do anything right"), and automatic emotional, behavioral, and symptomatic responses (eg, depression, withdrawal, and headache).

Mitchell and White (1976, 1977) have used a treatment approach with migraine patients similar to the cognitive-behavioral intervention described here. They taught clients to monitor cognitive and behavioral responses to stressful situations and to employ a series of strategies to cope with the stressful situations they identified (for example, self-instruction, negative thinking interruption, and affirmation training).




The relationships between stress and migraine are clear, as well as anxiety and sometimes depression can also sometimes be identified in people with chronic migraine.

For the improvement and / or total elimination of migraines, according to scientific data already demonstrated with evidence, the person with migraines can learn to manage them to reduce and / or eliminate them completely.

First, experts suggest that patients learn about situations, both in the environment and their thoughts and emotions that can cause migraines. Identify the patterns that migraines follow, analyze them as broadly as possible (diet, events, emotions, feelings, environment, work environment, etc.) Next, how do we perceive these aspects, from 0 to 10, what grade do we put on it? Is the event so serious or am I the one who gives it that importance?

The first strategy is the daily relaxation practice (3 times a day, 10 or 20 minutes each practice). Everyone chooses the relaxation that is most useful to them, but they all start with breaths, (yoga, music, guided visualizations, autogenous relaxation, meditation, mindfulness, etc.)

Without a doubt, mindfulness practice is the great ally of migraine sufferers. Not anticipating any event avoids the anxiety and stress that can trigger a migraine. Prioritizing daily activities, not wanting to do too many things and focus, concentrating on one activity is a surefire way to reduce stress.

Incorporating these strategies into the day-to-day life in a few weeks shows a clear improvement, reducing migraines and perhaps over time being able to live without medication in a healthier and happier way. However, the degree of commitment that we have to achieve the objective we want is going to be essential.


Carmen Martinez - Psicóloga y Coaching

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Celia Martínez Psicóloga
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