[Classification of patients with tension headache: irrationality, self-communication, stress reactions and pain.]

A review of the literature suggests that patients with tension headache do not differ from normals as much as from each other in psychological traits. The aim of the present study was to identify psychological subtypes of tension headache patients.

The subjects were 130 inpatients with a diagnosis of recurrent tension headache who were treated in a pain clinic. Six factors measured the constructs irrationality, positive and negative self-communication, emotionality, affective pain and situational pain.

Hierarchical agglomerative cluster analysis allowed the identification of five subtypes of patients. The reclassification rate was 95%. All patients endorsed, to a high degree, pain adjectives that expressed obstinate-refractory pain qualities. Most, i.e. 81%, indicated that they suffered from affective pain: 51.5% reported high situation-dependent and affective pain. They were comprised by two clusters, 30% showing high irrationality/negative self-communication and low positive self-talk communication and 21.5%, the opposite profile. A further 30% of the patients suffered from affective pain but reported no stimulus dependence. They were divided into two groups: 17% reported high, whereas 13% reported low positive self-communication. In 18.5% of cases the patients reported no psychological causation and demonstrated a state of inner placidity and low irrationality.

The results are discussed with reference to the literature and to indications for psychological treatment interventions.