title: Influence of psychological factors on acute exacerbation of tension-type headache: Investigation by ecological momentary assessment.
abstract: OBJECTIVE
  In this study, we investigated whether psychological factors were associated with subsequent acute exacerbation of tension-type headache (TTH) in a prospective and ecologically valid manner with computerized ecological momentary assessment.
  
  
  METHODS
  Eighteen women and five men with TTH wore watch-type computers that acted as an electronic diary for 1week. The subjects recorded momentary headache intensity, psychological stress, anxiety, and depressive mood with a visual analog scale of 0-100 approximately every 6h as well as when waking up, when going to bed, and at acute headache exacerbations. Multilevel logistic regression analysis with acute headache exacerbation occurrence as the outcome was conducted. Person-mean centering was applied to psychological factors to disaggregate between- and within-individual association.
  
  
  RESULTS
  Momentary psychological stress was associated with subsequent increase in headache exacerbation within 3h [Odds Ratio (95% CI)=1.32 (1.07, 1.64) for 10-point increments] while the individual mean of psychological stress was not.
  
  
  CONCLUSIONS
  These results support the possibility that psychological stress could trigger acute exacerbations of TTH.
authors.affiliation: Department of Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: kikuchih-tky@umin.ac.jp.
authors.forename: Hiroe
authors.initials: H
authors.lastname: Kikuchi
authors.affiliation: Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yoshiuchi
authors.affiliation: Department of Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ando
authors.affiliation: Educational Physiology Laboratory, Graduate School of Education, The University of Tokyo, Tokyo, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Yamamoto
mesh_terms: D000208:Acute Disease; D000328:Adult; D001008:Anxiety Disorders / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D011446:Prospective Studies; D012008:Recurrence; D013315:Stress, Psychological / Q000150:complications*; D018781:Tension-Type Headache / Q000523:psychology*
keywords: Ecological momentary assessment; Psychological stress; Tension-type headache