Role of Fear in Your Headache Disorder

A Study Revealing How Fear of Headaches May Make Them Worse

I'm Scared of My Head Pain. Steven Debenport/Getty Images

Do you find yourself avoiding social gatherings, restaurants, travel, or other possibly headache-triggering events out of fear you will develop a headache? If so, you are not alone. Many people fear the pain of their headaches and will do anything to avoid their triggers. But in reality, this fear of head pain may actually make your headache disorder worse—probably not something you expected.

How Fearing Your Headaches May Make Them Worse

One 2015 study in Headache examined the role of fear of pain in headaches in just over 900 young adults.

Of these participants, 382 denied a headache disorder and so served as the non-headache control group. Of the participants with headache (526 participants), about half experienced episodic tension-type headaches or episodic migraines. A smaller percentage (about 5 percent) had chronic migraine or chronic tension-type headache.

The participants filled out a series of surveys:

  • Depression, Anxiety, and Stress Scale (DASS-21): A 21 question test to assess feelings of depression, anxiety, and stress over the past week.
  • Headache Impact Test (HIT-6): A 6 question test used to determine the impact of one’s headache on daily functioning—including physical activities, cognitive or brain functioning, and emotional functioning—over the past 4 weeks.
  • Pain Anxiety Symptoms Scale-20 (PASS-20): A 20 question test to assess a person's fear of pain.
  • Structured Diagnostic Interview for Headache-Revised (SDIH-R): A 17 question test to assess the diagnosis of headaches, according to the second edition of the International Classification of Headache Disorders (ICHD-II).

    Results of the study showed that women reported more fear of pain of headaches than men. Those with more fear of pain of headache were also more likely to suffer from anxiety and depression.

    Results of the study also showed that the participants with tension-type headaches generally did not report higher fear of head pain compared to the non-headache participants .

    On the other hand, those with migraines reported more fear of pain than the non-headache participants—with the chronic migraineurs reporting the highest fear of pain.

    It's interesting to note too that the headache participants with a higher fear of head pain reported more severe headaches and more frequent headaches than those with lower fear of pain scores. Additionally, headache sufferers with more fear of pain had higher headache-related disability—which is how headaches affect a person's everyday functioning.

    Limitations of This Study

    Every study has limitations or reasons why we need to take a step back and not take the results as 100 percent true. For one, the study looked at young adults so these results may not apply to older adults with headaches. Secondly, the links between fear of pain and increased headache severity and disability are unclear. Is there some other factor mediating or playing a role in this association? Does a headache sufferer's fear of pain lead to more disability or vice versa?

    More studies are needed to tease apart this connection.

    What Can You Do If You Have Fear of Pain?

    Fear of pain is a common problem in people with headache disorders. Having this fear may make your headache disorder worse, especially when it comes to your daily functioning, like your social relationships, emotional well-being, and mental functioning.

    If you do suffer from fear of pain in headaches, please speak with your doctor. Cognitive-behavioral therapy—which will help you change your behavior and way of thinking—is one potential treatment your doctor may recommend to help you cope with your fear.


    Black AK, Fulwiler JC, & Smitherman TA. The role of fear of pain in headache. Headache. 2015 May;55(5):669-79.

    Psychology Society of Australia. Depression Anxiety Stress Scales. Accessed May 2015.

    Yang M, Rendas-Baum R, Varon S, & Kosinski M. Validation of the Headache Impact Test (HIT-6™) across episodic and chronic migraine. Cephalalgia. 2011 Feb; 31(3): 357–67.

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