LOS ANGELES—Among patients with headache, anxiety sensitivity was associated with a high number of reported headache triggers, high frequency of encountering triggers, and high likelihood of developing a headache after encountering a trigger. Fears related to physical concerns were most consistently associated with these three trigger variables, researchers reported at the 54th Annual Scientific Meeting of the American Headache Society.
In addition, participants were more likely to report types of headache triggers that were consistent with their particular anxieties. For example, patients with high social anxiety (eg, fear of others’ criticism) more often reported triggers that typically occur in social situations (eg, exercise or alcohol consumption).
A Survey of Patients With Headache
A. Brooke Walters, a doctoral candidate in psychology at the University of Mississippi in Oxford, and colleagues collected data from 669 individuals with headache to determine the relationship between trigger susceptibility and anxiety sensitivity—the irrational fear that benign sensations will have harmful consequences. The researchers administered the Anxiety Sensitivity Index-3 (ASI-3, which includes physical concerns, cognitive concerns, and social concerns subscales), conducted headache diagnostic interviews, and asked questions about headache triggers.
Participants’ mean age was 18.84, 68% were female, and 21.5% were of minority ethnicity. Approximately 21% of participants had episodic tension-type headache, 16.5% had probable tension-type headache, 15.2% had episodic migraine without aura, 6.2% had episodic migraine with aura, and 19.8% had probable migraine.
High Anxiety Correlates With A Large Number of Triggers
Women reported a higher total number of headache triggers than men, but high anxiety sensitivity was positively related to a high number of triggers in both genders. The frequency of encountering one’s most important trigger was positively related to scores on the physical concerns and social concerns subscales of the ASI-3 but inversely related to scores on the cognitive concerns subscale.
“These data provide support for fear-avoidance models of chronic pain … insofar as they underscore the importance of cognitive variables … as factors that contribute to the maintenance of pain over time,” said Ms. Walters. “They suggest that anxiety sensitivity may function as a previously understudied but important risk factor and target of behavioral therapy for trigger management.”
Anxiety Sensitivity Predicts Headache Frequency
High anxiety sensitivity was also associated with more frequent and disabling headaches, according to a related study reported at the meeting. Anxiety sensitivity was not correlated with high headache severity, however.
Significantly higher scores on the physical concerns subscale among migraineurs with aura suggest that fear of catastrophe resulting from physical sensations distinguishes these patients from migraineurs without aura and from patients with tension-type headache.
Interviewing Undergraduates With Headache
Rachel E. Davis, graduate student at the University of Mississippi in Oxford, and colleagues surveyed 850 undergraduate students to determine whether anxiety sensitivity could predict headache-related variables. Of these participants, 101 met diagnostic criteria for episodic migraine without aura, 41 met criteria for episodic migraine with aura, and 140 met criteria for episodic tension-type headache. The mean age of patients with headache was 19, and approximately 70% were female.
Participants completed the ASI-3 test and the Headache Impact Test-6 and provided information in a structured headache diagnostic interview. The researchers used multivariate analysis of variance to quantify differences in total score and in subscale scores between groups of patients. Linear regression was used to determine whether total score could predict headache frequency, severity, or headache-related disability.
Migraineurs With Aura Had Higher Anxiety Scores
Migraineurs with aura had a mean total score of 15.7 on the ASI-3, compared with 10.8 for migraineurs without aura and 10.3 for patients with episodic tension-type headache. In addition, migraineurs with aura scored 5.1 on the physical concerns subscale, compared with 2.6 for migraineurs without aura and 2.3 for patients with episodic tension-type headache. Differences between migraineurs with aura and other participants were statistically significant.
After controlling for gender, total score on the ASI-3 was a significant predictor of headache frequency for all participants with migraine, and of headache-related disability for migraineurs without aura and participants with tension-type headache. ASI scores did not predict headache severity.
“Studies should investigate anxiety sensitivity as a predictor of these headache variables among treatment-seeking samples and utilizing a larger sample of migraineurs with aura,” said Ms. Davis. “Treatment studies assessing the impact of modifying existing behavioral headache protocols to also reduce anxiety sensitivity on headache outcomes should be considered.”
—Erik Greb