Cephalalgiaphobia – Should we treat “the fear of headaches”?

Cephalalgiaphobia – that’s right, it’s the fear of headaches.  And, naturally, if you’ve had a few bad ones, you’re not going to want more.

But is this fear actually making the problem worse?

In 2007, researchers in Brazil suggested that cephalalgiaphobia should be a recognized phobia that needed to be further studied.

Now we need to understand that a “phobia”, in the technical medical sense, is not just concern that your pain is going to get worse.  It’s an irrational fear, a disorder that can actually cause other physical symptoms.

So here’s the problem – what is irrational or abnormal?  Here at Headache and Migraine News we do not consider headache to be “normal” or something to be ignored.  But surely a migraineur who avoids certain events because of a good mathematical chance that a migraine attack will strike cannot be called “irrational”.

Surely a headache sufferer who sees a pattern of worsening pain cannot be questioned if they’re concerned that their pain will increase.

There are a number of “between attack” problems that migraine sufferers may have.  Some physical symptoms may continue all the time, even when an attack isn’t happening at the moment.  And certainly anyone with chronic pain will learn how to cope in the real world by making decisions about where to go and what to do – partly based on levels of pain, chances of pain, and risk of increasing pain.

That’s not good – and it can be dangerous, but all things being equal it’s not necessarily a phobia.

However, as I say, it can be dangerous and get out of control.

In June of 2013, researchers from Italy and the USA continued investigating cephalalgiaphobia in migraine patients.  Here was their definition of cephalalgiaphobia:

Cephalalgiaphobia is the fear of having a headache attack during a pain-free period that may induce patients to use analgesic in the absence of pain to prevent headache and to improve their performances.

Again, the definition concerns me.  Technically, I would be very concerned if a headache patient was taking medication because of “fear”.  On the other hand, if someone knows that they will get a headache because they see migraine warning signs or because they almost always get a headache during a severe thunderstorm, and they take medication before the pain starts, knowing that that has solved the problem in the past – is that cephalalgiaphobia?

Researchers found that patients were more likely to take “unnecessary painkillers” if they had more headache attacks per month.  That is, the group with over 15 attacks per month were more likely to suffer from cephalalgiaphobia (as the authors defined it) than those with 4-14 or 1-3 attacks per month.

This is not a topic that should be ignored, and the researchers have legitimate concerns.  The fact that conditions such as depression often go along with migraine.  The risk of suicide in migraine patients.  The overuse of medication, and risk of medication overuse headache (rebound headache).

Should we be concerned that many patients take more medications than they need to?  Absolutely.

And one of the questions that patients were asked is certainly worth thinking about – Have you ever used painkillers to improve your performances and be more active, although you were not feeling the pain at all?

That’s no reason to take headache meds.  And it can be very dangerous.

But if you’ve ever taken medication, thinking the pain would increase, does that mean you have a phobia, or just experience?  If you fear a migraine attack when you’re feeling well, is that necessarily abnormal?  If you plan ahead knowing that you may have an attack, is that a phobia?

I think the researchers have valid concerns, and that these are questions that should be investigated further.  Far too little attention is given to the whole-life consequences of migraine.

But I think we need to be very cautious about how we define new clinical phobias.  We might end up taking too much time treating something that’s actually normal, and not enough time treating migraine and headache disorders.

The full details of the latest study can be found here:  Cephalalgiaphobia as a feature of high-frequency migraine: a pilot study