Abstract
In this paper chronic headache was discussed from a psychosomatic standpoint. From 1970 to 1979,521 patients whose chief complaint was headache were seen at the Clinic of Psychosomatic Medicine and Neurological Medicine of Nagoya University Hospital. They consisted of 14. 1% of all the patients. Depressed patients with chronic headache were analized. Seventy-nine patients with mild depression visited our clinic from 1971 to 1974. Forty-three of them complained of headaches. These headaches were neither throbbing nor strong, and mostly located in the occipital region. The nature of these headaches were similar to that of muscle contraction headache. However, muscle relaxant agents are not so effective that it is better to classify this as depressive headache which is different from muscle contraction headache. EMG activities of the temporal muscle were measured in 18 patients with muscle contraction headache. The control group consisted of 30 persons of the hospital staff. The mean muscle tension of the patient group was 2.49 μV, which was higher than that of the control group (P<0.01). At the time of measurement 8 patients complained of headache and the remaing 10 did not. The mean level of the former group was 2.56 μV and that of the latter 2.44 μV. Statistical analysis showed no significant difference between these two groups (P<0.05). The mean EMG Ievel of patients who did not complain of headache during measurement were higher than that of the control group (P<0.01). In some patients, EMG activities were lower than the mean value of the control group. These results indicate that muscle contraction headache is caused not only by muscle tension but by other factors. The pain threshold is an important factor. Headache is one type of pain, so that it is conceivable that headache consists of two components, that is, 1) a process to induce "pain stimulus" and 2) a process to perceive "pain sensation". Psychological factors are related to the three phases of these processes, the first is a productive process of preliminary physical constitution of headache, the second is a trigger of the first occurrence of symptom, and the third a process of alteration in the pain threshold.
