Lawrence D. Rodichok

Psychological functioning in headache sufferers.

&NA; The present study examined the psychological test responses of 99 headache sufferers and 30 matched nonheadache controls. Headache subjects were of four types: migraine (n = 26), muscle contraction (n = 39), combined migraine‐muscle contract ion (n = 22), and cluster (n = 12). Measures consisted of the Minnesota Multiphasic Personality Inventory, a modified hostility scale derived from the MMPI, Back Depression Inventory, State‐Trait Anxiety Inventory, Autonomic Perception Questionnaire, Rathus Assertiveness Schedule, Social Readjustment Rating Scale, Psychosomatic Symptom Checklist, Schalling‐Sifneos Scale, Need for Achievement, and Hostile Press. Significant differences were found on five clinical scales of the MMPI—1, 2, 3, 6, and 7. Of the non‐MMPI scales, only the Psychosomatic Symptom Checklist and Trait Anxiety Inventory were significant. Control subjects revealed no significant findings on any tests. The headache groups fell along a continuum, beginning with cluster subjects, who showed only minimal distress, continuing through migraine and combined migraine‐muscle contraction, and ending with muscle contraction subjects, who revealed the greatest degree of psychological disturbance. However, none of the headache groups could be characterized by marked elevations on any of the psychological tests, which contrasts with past research findings. It is suggested that the present results may be more representative of the “typical” headache sufferer.

Early diagnosis of spinal epidural metastases

Early signs of spinal cord injury on neurologic examination have been the primary indication to proceed with myelography in patients with possible spinal epidural metastases. With this approach, loss of ambulation occurs in more than one half of the patients. In an attempt to diagnose epidural metastases before the onset of myelopathy, we designed a prospective study based on the development of back pain, a precursor of spinal cord injury in nearly all cancer patients. Eighty-seven patients were studied. A high incidence of epidural metastases was found in patients with myelopathy (78 percent). In addition, patients with radiculopathy alone frequently had epidural tumor (61 percent). In 36 percent of the patients who presented with back pain but who had normal neurologic findings, there was evidence of epidural metastases on myelography; all of those patients had vertebral metastases on plain roentgenogram. Over-all, the plain roentgenogram of the spine correctly predicted the presence or absence of epidural tumor in 83 percent of the patients. Whereas 93 percent of the patients with myelopathy had more than 75 percent myelographic block, this occurred in 53 percent of those with radiculopathy and in only 33 percent of those with back pain and normal neurologic findings. In most cancer patients, spinal epidural metastases are both detectable and significantly less extensive before the onset of spinal cord injury.

Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or, the machines may be necessary some time of the time

Abstract Two studies are reported in which patients with chronic headache, who did not improve significantly as a result of a 10-session, 8-week relaxation training program, were subsequently treated with biofeedback. For the tension headache sufferers, 36% of the relaxation non-responders showed significant improvement with frontal EMG biofeedback training. For those with vascular headaches, 44% of the relaxation non-responders showed significant improvement with thermal biofeedback. Vascular headache patients with combined migraine and tension symptoms did better than those with only migraine. Psychological test scores significantly differentiated successful vs non-successful biofeedback responders.

The efficacy and cost-effectiveness of minimal-therapist-contact, non-drug treatments of chronic migraine and tension headache.

SYNOPSIS

Four process studies in the behavioral treatment of chronic headache.

Abstract Four studies of ‘process’ variables in the behavioral treatment of chronic headache are examined. No relation between headache activity-level reduction and therapist variables such as level of experience (study 1) or warmth, competence or helpfulness as perceived by the patient (Study 2) was found from treatments using relaxation training and/or biofeedback. A significant relation was found, however, between regularity of relaxation practice at home (Study 4) and headache-activity reduction and between regularity of showing some degree of hand warming in thermal biofeedback treatment for vascular headache and headache activity-level reduction (Study 3). Finally, no relation was found between changes in EMG and headache activity-level for tension-headache sufferers treated with frontal EMG biofeedback.

Nonpharmacologic treatment of chronic headache: prediction of outcome.

We studied the ability of headache history, a 4-week headache diary, standard psychological tests, and laboratory measures of psychophysiologic responses to stress to predict the outcome of relaxation therapy and biofeedback for three types of chronic headache. Using canonical discriminant function analyses, each potential predictor set was tested separately, and all four were tested together. Information from the headache history alone correctly classified 89 to 95% of patients as improved or unimproved. No other single predictor set was consistently better than headache history. When all four predictor sets were combined, prediction improved; 93 to 100% of patients were correctly classified.

Psychophysiological responses as predictors of response to behavioral treatment of chronic headache

A battery of psychophysiological responses including forehead EMG, skin temperature, skin resistance level and heart rate, measured under several conditions including baseline, self-relaxation, and self-control, and stresses such as mental arithmetic and cold pressor, was collected on patients with three types of headache prior to any treatment. With this battery we can predict from 31.5 to 70.2% of the variance in posttreatment headache activity level scores for patients treated with relaxation and biofeedback. Moreover, we can correctly classify as successful or unsuccessful, after either relaxation training or biofeedback training, from 72.7 to 89.7% of subsamples based on headache type and treatment regimen.

Glucose utilization is unchanged in red nucleus after axotomy

Separate series of adult rats were subjected to unilateral high cervical and low thoracic section of the rubrospinal tract and sacrificed 1-30 (cervical series) and 3-100 days (thoracic series) later. Local cerebral glucose utilization ([14C]2-DG method of Sokoloff et al.) was determined in the red nucleus and in the inferior colliculus, nucleus interpositus and sensorimotor cortex of both sides in operates and controls. Although severe atrophy of rubral neurons follows cervical tractotomy while reversible chromatolytic alterations occur after thoracic lesions, glucose utilization did not differ in the red nucleus of operated and control rats. However, glucose utilization increased slightly in the inferior colliculus of all operated animals, a finding of indeterminate significance. The failure of axotomized intrinsic neurons of red nucleus and their surround to show altered glucose utilization stands in sharp contrast to the marked increase which occurs in cranial nerve nuclei after axotomy of their contained extrinsic neurons. The data are held to constitute another indication that there is a fundamental difference in the metabolic responses of extrinsic and intrinsic mammalian neurons to axotomy and may support the contention that, in mammals, the axon reaction of intrinsic neurons is fundamentally different from that of extrinsic nerve cells. This difference may have significance for failure of axon regeneration in mammalian CNS.(ABSTRACT TRUNCATED AT 250 WORDS)