In order to gather information on the potential roles of stress, mood and psychological state in the etiology and exacerbation of migraine headache (and of other types of benign headache [HA] disorders), the project will gather prospective daily diary data over a six-week period on six variables: headache intensity, frequency of stressful events, perceived level of stress, mood states, medication consumed for headache, and, when appropriate, indications of two key points in the menstrual cycle of premenopausal women not on oral contraceptives: time of ovulation and time of onset of menstruation. The investigators believe the interrelations of these variables, HA, mood and stress, are complex. Available research on the topic has failed to examine all three in a prospective fashion using appropriate data analytic procedures and has failed to account for medication effects. This project will remedy these deficits and in so doing potentially point the way for the development of more effective drug non-drug treament of chronic, benign HA, especially a matching of treatment to the patient. Two-hundred and twenty-five patients with chronic HA (75 with migraine HA, 75 with tension-type HA, and 75 with combined or mixed migraine and tension-type HA) will monitor HA, perceived stress and mood states 4 times per day for 6 weeks using hand-held computers (HHCs). Subjects will be paid for participation. Subjects will also record all medications consumed and frequency of stressful events on a daily basis, and as appropriate, key points in their menstrual cycle. Although the focus is on migraine HA, two other groups are being run (tension-type HA and mixed HA) to help isolate factors and relations idiosyncratic to pure migraine as opposed to being related to chronic HA, per se. Similar perceived stress and mood ratings, as well as data on frequency of stressful events will be gathered from 50 paid control volunteers who do not suffer from a chronic HA disorder. New, sophisticated data analytic procedures will enable examination of the data on several temporal bases: 4 times per day, daily and weekly.
