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The frequency of precipitation of headache attacks by individual emotional states as well as the awareness of vulnerability to particular emotional precipitants were investigated in 90 consecutive patients with tension-type headache and 50 consecutive migraine subjects at an Outpatient Headache Clinic. There was differential emotional precipitation in tension-type headache and migraine, with patients with tension-type headache reacting more selectively to negative emotional arousal (anger, anxiety) and reporting a graded frequency of attack precipitation by individual emotional states. Migraine subjects reported a more uniform distribution of attacks among different emotional precipitants. The two groups also showed a differential awareness of vulnerability to individual emotional precipitants. A cognitive process screening the emotional precipitants of tension-type headache and migraine attacks is proposed, based on different cognitive schemata functioning either over-effectively or defectively. The significance of cognitive mediation of the precipitation of attacks is further emphasized for a comprehensive management of both tension-type headache and migraine.
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