Si l'on regroupe sous la dénomination migraines et céphalées de tension, les pathologies suivantes : les migraines sans aura, les névralgies d'Arnold, les céphalées d'origine cervicale, les céphalées de tension et les migraines accompagnées, les céphalées ainsi définies sont associées de manière significative à des désordres psychologiques. Les désordres psychologiques considérés sont l'anxiété et la dépression. Dans ces types de céphalées, les muscles faciaux, cervicaux, dorsaux et scapulaires présentent des tensions en excès, dont les points triggers sont les témoins. Le traitement des muscles contracturés associé à une prise en charge de relaxation permet une diminution très hautement significative de la symptomatologie douloureuse (intensité et périodicité). Le traitement apporte une diminution significative de l'anxiété-trait et de l'anxiété-état, ainsi qu'un réajustement des stratégies de coping. Pendant les périodes de crises de céphalées, l'anxiété et les stratégies de coping sont modifiées de manière significative. En dehors des épisodes de crises de céphalées il n'y a pas de caractéristiques d'anxiété ou de stratégie de coping différentes chez le céphalalgique et chez le non-céphalalgique, si ce n'est une utilisation plus grande du coping évitement chez le céphalalgique (notons que durant la période de crise de céphalées, ce coping est également plus utilisé). D'autre part, la kinésithérapie-relaxation agissant en diminuant l'anxiété-trait, on peut entrevoir un profil psychologique de la personne céphalalgique et comprendre le rôle de la relaxation, médiatrice de gestion du stress et de l'anxiété qui y est liée dans l'assouplissement de la notion de prédisposition génétique aux céphalées.

Since the 1950's and even still today, the concomitance between headaches and psychological symptoms (anxiety and depression) is the subject of considerable research. Even so, headaches still pose a problem of difficult diagnosis related to their multiform aspect. Their understanding may be regarded as neurological, psychological or musculo-articular. This complexity explains the lack of effectiveness of anti-migraine treatments in certain cases. This situation encourages recourse to complementary procedures such as those used in physiotherapy. The questions that could be posed regarding physiotherapeutic treatment are : Is the treatment effective ? How does it act on the level of pain ? and How does it act at the psychological level ? It is to answer these questions that the work, which is the basis of this article, has been carried out. Methodology - Two groups were studied during this research : a group of 25 patients and a reference group of 100 people. The headache patients were sent for physiotherapy by a GP or consultant neurologist. The pathologies retained for experimentation were : migraines without aura ; Arnold's neuralgia ; headaches of spinal origin ; tension headaches and associated migraines. These pathologies are covered in International Headache Society Classification : « Essential headache» and in Section 45.4 of DSM IV : « Painful problems ». The physiotherapeutic treatments applied to the patients were : muscular massage and friction plus ultra-sound vibration of the trigger-points in the spinal, scapular, dorsal and facial regions ; articular reharmonisation work on the spinal column ; thermotherapy and relaxation as a technique allowing control of physical (muscular) and psychological (anxiety, fear of pain) tension to be regained. The treatment is evaluated by comparison of the periodicity and intensity of the headaches before and after treatment ; comparison of anxiety (state and trait) before and after treatment and comparison of coping strategies before and after treatment. Results - As far as the description of the headaches of the patient group is concerned, the periodicity/intensity evaluated each day of the week before the treatment and presented in graphical form, showed a heterogeneous distribution and did not exhibit any particular characteristics. In addition, the fact of having studied this periodicity/intensity during a period of one week reinforces the reliability of the values found and reinforces the impact, showing clearly that it is not just incidental. The headaches were hereditary in 32-64 % of cases ; the trigger factors related to stress were the large majority. As far as the treatment used in the population studied is concerned, medication was used punctually, as prescribed. This was in the form of analgesics/antipyretics (68 %) or anxiolytics (20 %). In 85 % of the cases, at the end of the physiotherapy treatment, the person no longer used any medication. The effectiveness of the treatment is clearly illustrated by the fact that the periodicity/intensity of the headaches had diminished significantly after treatment. The physiotherapy treatment lasted for 10 to 20 sessions with an average duration of 14 sessions. The treatment results in a significant reduction in the anxiety trait and the anxiety state as well as a readjustment of the coping strategies. During periods of headache crisis, anxiety and coping strategies are modified significantly. The modifications to these coping strategies during crises are : an increase in auto-accusation, the search for social support, avoidance and strategies for the resolution of emotion prior to treatment ; an increase in strategies for the resolution of the problem after treatment ; coping self-control is diminished if the anxiety state increases and it increases if the anxiety trait increases. Apart from the headache crises, there are no differences in anxiety characteristics or coping strategies between headache sufferers and others except for a greater use of coping avoidance by the headache sufferer. Conclusion - Treatment by relaxation allows for a perceived increase in control of symptoms by the sufferer. Consequently, it reduces anxiety, improves the quality of life and the behavioural responses to stress. In turn, the treatment improves the long-term prognosis for the headaches as well as the health of the sufferer in general. The treatment described here addresses 3 types of people : 1. Sufferers with « difficult » headaches which do not respond well to medical treatment. 2. People for whom anxiety and coping strategies are very much modified by the headaches. 3. People who abuse medication for the treatment of their headaches.