Acquisition and extinction of headache-eliciting properties of trigger factors

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Standard advice in the clinical management of headaches is to counsel headache sufferers to avoid any factors that could trigger a headache. There is a compelling logic to this approach but is there a danger that it amounts to being over-protective in the sense that it encourages headache sufferers to 'cocoon' themselves from situations that could give rise to headaches, ultimately resulting in them losing their ability to cope with such situations. Certainly, avoiding situations that elicit anxiety leads to a sensitisation process whereby the situations elicit greater anxiety. And the converse is true, exposure to anxiety-eliciting situations results in a desensitisation process whereby the situations elicit less anxiety. Whether avoidance or exposure is more appropriate in the management of headache disorders depends on the processes by which sensitivity to trigger factors is gained and lost. Two studies will be completed that test different models of these processes. The expected outcome of these studies is that they will support the theory that stimuli acquire the capacity to elicit headaches as a function of individuals trying to avoid or escape from any factor that they believe could trigger a headache. This sensitisation process can be reversed by prolonged exposure to headache trigger factors. Such results would suggest that the established practice of counselling headache sufferers to avoid triggers is counterproductive as it may lead to a reduction of headaches in the short-term but may also lead to an insidious sensitisation process that ultimately results in an increase in headaches. Given that headaches are so common and associated with such high direct and indirect costs, changes in clinical management arising from these findings could have major benefits to individuals, families and society.