Noradrenaline and cortisol changes in response to low-grade cognitive stress differ in migraine and tension-type headache

The goal of this study was to explore the relationship between indicators of sympathoneural, sympathomedullar and hypothalamic-pituitary-adrenocortical (HPA) activity and stress-induced head and shoulder-neck pain in patients with migraine or tension-type headache (TTH). We measured noradrenaline, adrenaline and cortisol levels before and after low-grade cognitive stress in 21 migraineurs, 16 TTH patients and 34 controls. The stressor lasted for 60 min and was followed by 30 min of relaxation. Migraine patients had lower noradrenaline levels in blood platelets compared to controls. Pain responses correlated negatively with noradrenaline levels, and pain recovery correlated negatively with the cortisol change in migraineurs. TTH patients maintained cortisol secretion during the cognitive stress as opposed to the normal circadian decrease seen in controls and migraineurs. There may therefore be abnormal activation of the HPA axis in patients with TTH when coping with mental stress, but no association was found between pain and cortisol. A relationship between HPA activity and stress in TTH patients has to our knowledge not been reported before. In migraine, on the other hand, both sympathoneural activation and HPA activation seem to be linked to stress-induced muscle pain and recovery from pain respectively. The present study suggests that migraineurs and TTH patients cope differently with low-grade cognitive stress

Autonomic and muscular responses and recovery to one-hour laboratory mental stress in healthy subjects

<p>Abstract</p> <p>Background</p> <p>Stress is a risk factor for musculoskeletal pain. We wanted to explore stress related physiology in healthy subjects in order to gain insight into mechanisms of pain development which may relate to the pathophysiology of musculoskeletal pain disorders.</p> <p>Methods</p> <p>Continuous blood pressure, heart rate, finger skin blood flow, respiration, surface electromyography together with perception of pain, fatigue and tension were recorded on 35 healthy women and 9 healthy men before, during a 60 minute period with task-related low-grade mental stress, and in the following 30 minute rest period.</p> <p>Results</p> <p>Subjects responded physiologically to the stressful task with an increase in trapezius and frontalis muscle activity, increased blood pressure, respiration frequency and heart rate together with reduced finger skin blood flow. The blood pressure response and the finger skin blood flow response did not recover to baseline values during the 30-minute rest period, whereas respiration frequency, heart rate, and surface electromyography of the trapezius and frontalis muscles recovered to baseline within 10 minutes after the stressful task. Sixty-eight percent responded subjectively with pain development and 64% reported at least 30% increase in pain. Reduced recovery of the blood pressure was weakly correlated to fatigue development during stress, but was not correlated to pain or tension.</p> <p>Conclusion</p> <p>Based on a lack of recovery of the blood pressure and the acral finger skin blood flow response to mental stress we conclude that these responses are more protracted than other physiological stress responses.</p

Cardiovascular responses to cognitive stress in patients with migraine and tension-type headache

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to investigate the temporal relationship between autonomic changes and pain activation in migraine and tension-type headache induced by stress in a model relevant for everyday office-work.</p> <p>Methods</p> <p>We measured pain, blood pressure (BP), heart rate (HR) and skin blood flow (BF) during and after controlled low-grade cognitive stress in 22 migraineurs during headache-free periods, 18 patients with tension-type headache (TTH) and 44 healthy controls. The stress lasted for one hour and was followed by 30 minutes of relaxation.</p> <p>Results</p> <p>Cardiovascular responses to cognitive stress in migraine did not differ from those in control subjects. In TTH patients HR was maintained during stress, whereas it decreased for migraineurs and controls. A trend towards a delayed systolic BP response during stress was also observed in TTH. Finger BF recovery was delayed after stress and stress-induced pain was associated with less vasoconstriction in TTH during recovery.</p> <p>Conclusion</p> <p>It is hypothesized that TTH patients have different stress adaptive mechanisms than controls and migraineurs, involving delayed cardiovascular adaptation and reduced pain control system inhibition.</p

Respiration frequency and heart rate before (Baseline, Feedback), during (0–10, 10–20,

<p><b>Copyright information:</b></p><p>Taken from "Autonomic and muscular responses and recovery to one-hour laboratory mental stress in healthy subjects"</p><p>http://www.biomedcentral.com/1471-2474/8/81</p><p>BMC Musculoskeletal Disorders 2007;8():81-81.</p><p>Published online 14 Aug 2007</p><p>PMCID:PMC2045095.</p><p></p>., 50–60 min) and after (65–75, 75–85, 85–95 min) the stressful task. Mean values for periods of 10 minutes (Baseline, Feedback: 5 min) are shown

Tension and pain development throughout the stress test and recovery period

<p><b>Copyright information:</b></p><p>Taken from "Cardiovascular responses to cognitive stress in patients with migraine and tension-type headache"</p><p>http://www.biomedcentral.com/1471-2377/7/23</p><p>BMC Neurology 2007;7():23-23.</p><p>Published online 7 Aug 2007</p><p>PMCID:PMC2048502.</p><p></p> Values given as group means (SEM), where maximal reported pain (from the trapezius, splenius, temporalis and frontalis areas, irrespective of side) for each subject was used in the calculations. T = 0 – 60: During the cognitive stress test. T = 65 – 95: Relaxation period after the test

Blood pressure recovery (value at 95 min – baseline) plotted against the fatigue response with linear regression line shown

<p><b>Copyright information:</b></p><p>Taken from "Autonomic and muscular responses and recovery to one-hour laboratory mental stress in healthy subjects"</p><p>http://www.biomedcentral.com/1471-2474/8/81</p><p>BMC Musculoskeletal Disorders 2007;8():81-81.</p><p>Published online 14 Aug 2007</p><p>PMCID:PMC2045095.</p><p></p> The association is significant (r= 0.34, p = 0.03)

Mean blood pressure and finger skin blood flow (SBF) before (Baseline, Feedback), during (0–10, 10–20,

<p><b>Copyright information:</b></p><p>Taken from "Autonomic and muscular responses and recovery to one-hour laboratory mental stress in healthy subjects"</p><p>http://www.biomedcentral.com/1471-2474/8/81</p><p>BMC Musculoskeletal Disorders 2007;8():81-81.</p><p>Published online 14 Aug 2007</p><p>PMCID:PMC2045095.</p><p></p>., 50–60 min) and after (65–75, 75–85, 85–95 min) the stressful task. Mean values for periods of 10 minutes (Baseline, Feedback: 5 min) are shown. Au = arbitrary units

Tension, fatigue and pain scores in the maximal pain location before (0 min), during (10, 20,

<p><b>Copyright information:</b></p><p>Taken from "Autonomic and muscular responses and recovery to one-hour laboratory mental stress in healthy subjects"</p><p>http://www.biomedcentral.com/1471-2474/8/81</p><p>BMC Musculoskeletal Disorders 2007;8():81-81.</p><p>Published online 14 Aug 2007</p><p>PMCID:PMC2045095.</p><p></p>., 60 min) and after (75, 85, 95 min) the stressful task

Surface electromyographic (SEMG) activitity before (Baseline, Feedback), during (0–10, 10–20,

<p><b>Copyright information:</b></p><p>Taken from "Autonomic and muscular responses and recovery to one-hour laboratory mental stress in healthy subjects"</p><p>http://www.biomedcentral.com/1471-2474/8/81</p><p>BMC Musculoskeletal Disorders 2007;8():81-81.</p><p>Published online 14 Aug 2007</p><p>PMCID:PMC2045095.</p><p></p>., 50–60 min) and after (65–75, 75–85, 85–95 min) the stressful task. Mean RMS values for periods of 10 minutes (Baseline, Feedback: 5 min) are shown