The role of stressful life events in the onset of chronic primary headache

This study investigated the relationship between stressful life events and the onset of chronic primary headache (CPH), using both normative group ratings and self-report ratings of the desirability and the perceived impact of stressful events. We hypothesized that CPH patients (n = 63) would report significantly more stressful life events with negative impact on their life style in the year prior to headache onset compared with headache-free controls (n = 44). The prediction was fully confirmed. CPH patients were exposed to a significant increase (P less than 0.001) in their final year life change unit (LCU) totals prior to headache onset as compared to the previous corresponding time interval and to headache-free controls. Furthermore, a highly significant peaking (P less than 0.001) of negative change scores, based on personal ratings of the distress concerning life events in the same time interval, was observed in the CPH group. In terms of event content, exits or losses were prominent in being perceived as stressful. Significant differences between headache subgroups (chronic tension-type headache, migraine, mixed headache and psychogenic headache) were not found, although mixed headache sufferers reported a higher incidence of interpersonal arguments and difficulties than migrainous patients. We conclude that a sudden increase in the frequency and magnitude of stressful life events, associated with a cognitive-emotional appraisal of their negative impact on life patterns, appears to herald the onset of headache, independently of the developing clinical headache syndrome.