The Phobia of Having Headaches

A Closer Look into Cephalalgiaphobia

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Does fear play a role in your migraines? Do you find yourself panicking when you encounter a migraine trigger, like a change in weather or an alcoholic beverage? Let's take a closer look into a study on cephalalgiaphobia, a psychiatric condition that refers to an individual's intense fear of developing a headache.

What is Cephalalgiaphobia?

A study in The Journal of Headache and Pain examined the relationship between cephalalgiaphobia and migraines.

The authors defined cephalalgiaphobia as: "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 headaches and to improve their performances." In other words, cephalalgiaphobia refers to fear over an anticipated headache and is often linked to medication-overuse to mitigate that fear or phobia. It's like taking an ibuprofen before your headache or aura even occurs.

What is the Link Between Migraines and Psychopathology?

There are many studies that have reported a link between migraines and psychiatric disorders, especially depression and various anxiety disorders like panic attacks, obsessive-compulsive disorders, generalized anxiety disorder, and phobias. Feeling of hopelessness and a person's perception of disability have also been linked to migraines.

Even more, psychiatric disorders can modify the course of migraines by increasing the likelihood of transformation from episodic to chronic migraines and increasing the risk of medication overuse.

Migraines, too, can exacerbate psychiatric disease, as evidenced by the increased suicide attempt rate in migraineurs.

Does Cephalalgiaphobia Worsen Migraines?

Let's take a closer look at this study in The Journal of Headache and Pain.

Purpose: The study's objective was to examine the relationship between cephalalgiaphobia and migraine frequency as well as medication overuse.

Methods: A headache specialist performed an interview on over 120 migraineurs at baseline and two years later. The following questions were used to assess the subject's level of cephalalgiaphobia. These items were scored based on the frequency of occurrence (never=0; sometimes=1; often/always =2) for a possible score range from 0 to 8.

1. When you are feeling well do you ever fear to have a migraine attack?

2. Have you ever used painkillers even though you were not having pain just because you were scared of a possible migraine attack?

3. Have you ever used a second dose of painkilling drugs just because you feared that the pain would get worse before it actually did?

4. Have you ever used painkillers to improve your performances and be more active, although you were not feeling the pain at all?

The subject's migraine frequency and monthly use of acute migraine treatments were also reported at baseline and two years later.

Main Results:

  • Migraineurs with more frequent attacks were more likely to suffer from cephalalgiaphobia.
  • Cephalalgiaphobia was more common in individuals with medication-overuse than in those without.
  • Migraineurs whose migraine frequency worsened at the two year-followup had an increase in their cephalalgiaphobia score compared to those whose frequency stayed the same or improved. This suggests that cephalalgiaphobia may play a role in the worsening of migraine frequency over time.

Limitations: Limitations were noted by the study authors including the following:

  • The four question survey used to assess cephalalgiaphobia is not a validated questionnaire.
  • Other variables, which could affect the results, were not analyzed including other medications the patients were taking as well as psychiatric conditions that may have.
  • A small number (120) of patients participated.

These limitations do not mean that we should disregard the results. Rather, we should understand them for what they are. There likely is a link between migraines and cephalalgiaphobia, but we need more studies to further examine the relationship.

What is The Big Picture?

First of all, the strong association between migraines and psychiatric illness indicates that migraineurs should be assessed by their doctors for psychiatric disease, especially mood disorders, like phobias. On the other hand, patients with migraines AND a diagnosed underlying psychiatric illness should be monitored closely for headache exacerbation.

Secondly, suffering from cephalalgiaphobia could increase your migraine occurrences and lead to overuse of analgesics. It is unclear from this study whether cephalalgiaphobia directly increases migraine frequency or leads to overuse of analgesics, which then precipitates a vicious migraine cycle. Further studies are needed to tease apart this association.

Take Home Message

If you suffer from migraines or any headache disorder and notice mood symptoms that are affecting your everyday quality of and functioning in life, please share your concerns with your doctor and loved ones. Likewise, if you suffer from a psychiatric illness and notice worsening of your migraines, please speak with your healthcare provider so a treatment plan can be devised. 


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Giannini G, Zanigni S, Grimaldi D, Melotti R, Pierangeli G, Cortelli P, Cevoli S. Cephalalgiaphobia as a feature of high-frequency migraine: a pilot study. J Headache Pain. 2013; 14(1): 49.

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DISCLAIMER: This site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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