Psychophysiological responses of female headache sufferers and controls using a picture-viewing paradigm

Despite the advancement of the biopsychosocial model, the interrelationship between behavioral, emotional, and physiological factors in tension-type headache (TTH) remains unclear. Using a picture-viewing paradigm, the present study investigated differences between females with TTH and controls on physiological reactivity, affective valence and arousal, and oral motor habits. In addition, the concordance between EMG activity and self-reported oral habits (i.e., proprioceptive awareness) and EMG activity and self-reported affect (i.e., affective coherence) were measured using within-subject correlations per individual and then compared between groups. Data were analyzed for 27 TTH sufferers and 27 controls who completed a questionnaire packet followed by a psychophysiological assessment consisting of 3 phases (adaptation, scheduled-viewing, recovery) with EMG activity recorded continuously at 3 sites (frontalis, corrugator, zygomatic). During the scheduled-viewing phase, participants were presented with 24 pictures designed to elicit positive, neutral, and negative affect. Compared to controls, the headache group reported elevations in pain, oral habits, and stress across the 3 phases of the assessment, along with elevations in arousal while viewing the pictures. There were no significant differences between the groups in EMG activity while viewing the pictures. Analyses on concordance revealed partial evidence for poor proprioceptive awareness and affective coherence among the headache group, although the correlations were not significantly different than the control group. These findings suggest that arousal, stress perception, and oral habits may play a role in the pathophysiology of TTH and that within-subject designs should be tested further against group designs when measuring psychophysiological concordance.