Donald A. Bakal

Muscle Contraction and Migraine Headache: Psychophysiologic Comparison†

SYNOPSIS

Cognitive behavioral treatment of chronic headache.

SYNOPSIS

Tactile extinction and functional status after stroke. A preliminary investigation.

Research has identified a number of factors associated with poststroke recovery, but the prediction of long-term functional outcome remains an uncertain endeavor. In previous work, extinction to tactile, doublesimultaneous stimulation has been shown to have short-term predictive utility. The present study was designed to examine its long-term prognostic value and to determine the relative importance of tactile extinction, cognitive functioning, and visual neglect as predictors of poststroke functional status. Methods Successive admissions to an acute-care facility (n=26) were assessed three times: 1 month, 3.5 months, and 6 months after stroke. Hierarchical multiple regression, a procedure that maximizes the effect of the variables first entered, was used to predict functional status. Cognitive functioning and visual neglect were forced into the equation on the first step; tactile extinction was entered on the second step. Multivariate analysis of variance was used to compare the functional status of subjects with no extinction versus those who demonstrated extinction at the first assessment and later improved and those who continued to manifest the deficit. Results Tactile extinction on the left-hand side of the body was the most important predictor of functional outcome. A significant group-by-time interaction implied that the course of improvement in functional status differed between the groups. Conclusions Tactile extinction shows promise as a predictor of poststroke functional status, but further work is required to substantiate the present findings.

Symptom Characteristics of Chronic and Non‐Chronic Headache Sufferers

SYNOPSIS

Minding the body : clinical uses of somatic awareness

The Nature of Somatic Awareness. Somatization. Self-Medication Versus Self-soothing. Self-regulation and Immunity. Helping Others Find Their Bodies.

The Differential Contribution of Muscle Contraction and Migraine Symptoms to Problem Headache in the General Population

SYNOPSIS

Nonverbal expressiveness and EMG activity in tension headache sufferers and controls

This study explored the relationship between musculoskeletal responses and nonverbal expressiveness in response to psychosocial stress. Muscle-contraction headache subjects and normal controls were confronted with a psychological stressor while forehead and neck EMG activity were recorded. Indices of nonverbal expressiveness (head and hand movements, facial tension, facial activity, and facial expressiveness) were obtained concomitantly with the muscle data. The headache subjects showed greater muscle activation than the controls in response to stress, greater evidence of facial tension, and less evidence of facial and bodily expressiveness. Overall, these data provided support for the notion that under some conditions a negative relationship exists between expressiveness and somatic activation.

Illness behavior and chronic headache

Abstract Illness behavior was examined in chronic headache sufferers within the context of the psychobiological or severity model of headache. A Procrustes factor analytic procedure demonstrated the appropriateness of using the existing IBQ factor structure with chronic headache patients. The dimensions of illness behavior were not found to be related to headache diagnosis (muscle contraction, migraine, combined) nor to topographical properties of head pain which are used to infer diagnosis (forehead, bilateral, sides, unilateral). Headache patients who experienced the greatest amount of headache activity during a 21‐day self‐observation period were found to view their disorder in somatic as opposed to psychological terms. A comparison of patients with continuous pain and patients with episodic pain provided additional support for the somatic‐psychological distinction. Patients with continuous head pain viewed their disorder in somatic terms and also scored higher on the dimension of denial than did patients with episodic pain. Taken together these data demonstrated the utility of examamining psychological components of the chronic headache syndrome from a severity perspective.

Relationships between pain, cognitive activity and epidural analgesia during labor

&NA; This study examined the dynamic interplay between subjective pain, pain behavior and cognitive activity during the latent (⩽ 3 cm), mid‐active (5–7 cm) and transition (⩽ 8 cm) phases of labor in 115 nulliparous women. Subjects received no analgesia during the latent phase and either no analgesia or epidural analgesia, during the active and/or transition phase. Data were analyzed according to phase and analgesic condition. For subjects with no epidural analgesia, both the Present Pain Intensity (PPI) and the Present Behavioral Intensity (PBI) scores were correlated within and between phases. In contrast, Coping/Distress scores were weakly correlated between the latent and active labor phases and were unrelated between the active and transition phases. PPI and Copin/Distress scores were highly correlated within the latent phase but were independent within the active and transition phases of labor. PBI and Coping/Distress scores were moderately correlated within the latent and active phases and were unrelated during the transition phase. Epidural techniques reduced subjective pain and pain behavior significantly but had no apparent effect on the coping or distress‐related cognitive activity characteristic of active labor. We concluded that coping and distress‐related cognitive activity in labor may follow a phase‐specific pattern which is relatively independent of pain or pain relief after labor has become active.

Subjective distress accompanying headache attacks: Evidence for a cognitive shift

&NA; This study examined the nature of the cognitions experienced by chronic headache sufferers during headache episodes and assessed whether these cognitions were differentially related to illness behavior and to symptom properties of headache attacks. The data were examined both in terms of headache severity and in terms of the muscle contraction‐migraine dichotomy. Forty‐four headache patients monitored, with an open‐ended assessment format, the thoughts and feelings experienced prior to and during episodes of head pain. The majority of patient responses could reliably be placed into 1 of 2 categories: (a) stress‐related cognitions and (b) disorder‐related cognitions. The percentage of headache‐related thoughts and feelings correlated significantly with several indices of headache severity, including intensity of pain, quality of pain, length of headache attacks, and presence of early morning onset. Further significance to these findings was added by demonstrating that the patients who predominantly reported disorder‐related cognitions also displayed a tendency to deny life problems not related to pain. The data were taken as support for the hypothesis that chronic headache disorders of increased severity are accompanied by a cognitive shift whereby the patients primary concern moves from situational and interpersonal stress to distress associated with the disorder itself.