Influence of psychological factors on acute exacerbation of tension-type headache: Investigation by ecological momentary assessment.

OBJECTIVE

In this study, we investigated whether psychological factors were associated with subsequent acute exacerbation of tension-type headache (TTH) in a prospective and ecologically valid manner with computerized ecological momentary assessment.

METHODS

Eighteen women and five men with TTH wore watch-type computers that acted as an electronic diary for 1week. The subjects recorded momentary headache intensity, psychological stress, anxiety, and depressive mood with a visual analog scale of 0-100 approximately every 6h as well as when waking up, when going to bed, and at acute headache exacerbations. Multilevel logistic regression analysis with acute headache exacerbation occurrence as the outcome was conducted. Person-mean centering was applied to psychological factors to disaggregate between- and within-individual association.

RESULTS

Momentary psychological stress was associated with subsequent increase in headache exacerbation within 3h [Odds Ratio (95% CI)=1.32 (1.07, 1.64) for 10-point increments] while the individual mean of psychological stress was not.

CONCLUSION

These results support the possibility that psychological stress could trigger acute exacerbations of TTH.