Acquisition and extinction of headache-eliciting properties of trigger factors

临床治疗头痛的标准建议是建议头痛患者避免任何可能引发头痛的因素。这种方法有一个令人信服的逻辑，但它是否存在一种危险，即它等同于过度保护，因为它鼓励头痛患者将自己从可能引发头痛的情况中解脱出来，最终导致他们失去应对这种情况的能力。当然，避免引发焦虑的情况会导致一个敏感的过程，在这个过程中，情况会引发更大的焦虑。反之亦然，暴露在引发焦虑的情况下会导致脱敏过程，从而减少焦虑。在头痛障碍的治疗中，回避或暴露是更合适的，取决于对触发因素获得和失去敏感性的过程。将完成两项研究，以测试这些过程的不同模型。这些研究的预期结果是，它们将支持这样一种理论，即刺激获得引发头痛的能力是个人试图避免或逃避他们认为可能引发头痛的任何因素的函数。这种敏感化过程可以通过长期暴露在头痛触发因素中而逆转。这些结果表明，指导头痛患者避免触发因素的既定做法适得其反，因为它可能会在短期内减少头痛，但也可能导致潜伏的敏感化过程，最终导致头痛增加。鉴于头痛如此普遍，并与如此高的直接和间接成本相关，这些发现引发的临床管理方面的变化可能会给个人、家庭和社会带来重大好处。

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.