Cephalalgiaphobia: a possible specific phobia of illness

Abstract

Psychiatric comorbidity, mainly anxiety and depression, are common in chronic migraine (CM). Phobias are reported by half of CM patients. Phobic avoidance associated with fear of headache or migraine attack has never been adequately described. We describe 12 migraine patients with particular phobic-avoidant behaviours related to their headache attacks, which we classified as a specific illness phobia, coined as cephalalgiaphobia. All patients were women, mean age 42, and all had a migraine diagnosis (11 CM, all overused acute medications). Patients had either a phobia of a headache attack during a pain-free state or a phobia of pain worsening during mild headache episodes. Patients overused acute medication as phobic avoidance. It is a significant problem, associated with distress and impairment, interfering with medical care.Cephalalgiaphobia is a possible specific phobia of illness, possibly linked to progression of migraine to CM and to acute medication overuse headache.

Cervico-cephalalgiaphobia: a subtype of phobia in patients with cervicogenic headache and neck pain? A pilot study

“…We agree with Peres et al 4 who hypothesised that 'cephalalgiaphobia may decrease the threshold for initiating analgesic consumption behaviour, leading to acute medication overuse'. Despite the differences between the two studies, our study points to a use of medication with insufficient effect by patients with CEH of around 80%.…”

“…'Confirmation of "locked" facet joints of the neck by the MPT as a cause for increase of headache' scored 'often/ always' in all patients. 'Increased use of medication with insufficient effect' scored 'often/always' in four (8.7%) patients, while it was substantially covered by 'sometimes' Table 1 Peres et al 4 and Giannini et al 5 about the decrease of threshold for initiating the analgesic consumption behaviour leading to acute medication overuse, our hypothesis is that cervico-cephalalgiaphobia may lead to a behaviour of increased use of manual physical therapy, resulting in overuse of treatment sessions involving manipulation of the neck. However, further work is required to support this hypothesis.…”

“…2 In 2008, a study reviewed relevant articles published on specific phobias during the previous 2 years, including two officially recognised specific phobias (fear of spiders and blood, injection/ injury) and two 'unofficial' specific phobias (fever phobia and cephalalgiaphobia). 3 Peres et al (headache clinic in Brazil) 4 used the term 'cephalalgiaphobia' to describe 12 migraine patients with phobic-avoidant behaviour (overuse of medication) related to their headache attacks, classifying the behaviour as a possible specific illness phobia. In a recent pilot study by Giannini et al (headache clinic in Italy), 5 moderate-high migraine frequency was associated with higher risk of cephalalgiaphobia.…”

Understanding migraine and psychiatric comorbidity

“…Avoidance of perceived migraine triggers through restriction of daily activities may be a substantial driver of migraine-related disability [28]. Early cross-sectional studies suggest that avoidance of migraine through taking medication prior to the start of head pain [29], or reducing cognitive exertion to avoid triggering a migraine [30], may also contribute to the cycle of fear of pain and avoidance in migraine. Understanding the role of maladaptive physiological, psychological, and behavioral patterns shared between migraine and anxiety disorders will provide guidance for treatment options for people with comorbid migraine and anxiety disorders.…”

Fájdalomcsillapító-túlhasználathoz társuló fejfájás

“…A fejfájástól való félelem (cephalgiaphobia) klinikai jellemzőit tekintve kimeríti a specifi kus fóbiák DSM-IV. szerinti kritériumait [44]. Későbbi tanulmányokban megállapítást nyert, hogy a cephalgiaphobia kockázata a migrén gyakoriságával pár-huzamosan nő [45], illetve viselkedésterápiás módsze-rekkel csökkenthető, amivel párhuzamosan a fejfájás javul [46].…”