Is Overthinking a Migraine Trigger?

Patient Expert & Health Professional
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In our quest to identify and avoid Migraine triggers, we can sometimes become hypervigilant and make incorrect assumptions about possible triggers. It is a delicate balance between healthy avoidance of known triggers and paralyzing anxiety. If we’re not careful, we can easily become fearful of nearly everything in our environment. One such fear is called cogniphobia.

What is it?

Cogniphobia is the fear and avoidance of mental exertion (thinking too hard) based on the belief that doing so will trigger or worsen head pain. It was first noted in patients with post-trauma headache. A self-report screening questionnaire was developed to identify those who struggled with this fear. However, this C-Scale did not easily apply to patients with Migraine or other headache disorders. A new screening tool, The Cogniphobial Scale for Headache Disorders (CS-HD), was recently developed to identify Migraine patients who may struggle with cogniphobia.

Cogniphobia is not to be confused with the very real cognitive impairments that are commonly present during a Migraine attack. Aphasia, word loss, and difficulty focusing attention are well-established cognitive symptoms of acute Migraine attacks. Of course, we have difficulty during attacks. It should also not be confused with the cognitive side effects of commonly prescribed migraine preventives. Cogniphobia occurs between attacks (interictally), causing us to avoid mentally taxing activities out of fear that concentration itself will trigger an attack.

Why does it matter?

Our lives can become restrictive enough when trying to avoid genuine Migraine triggers. The last thing any of us needs is to be limited by irrational fears. Cogniphobia may hold us back from achieving our potential when we limit our career options based on these fears. It may also leave us vulnerable to poor acute Migraine management because we avoid the cognitively demanding process of tracking symptoms, responding to acute attacks, and avoiding our true triggers. Untreated, cogniphobia may contribute to higher rates of disability.

What can we do about it?

Like all irrational fears, cogniphobia can be treated. That treatment usually involves a combination of Migraine education, cognitive restructuring (changing thinking patterns), and gradual exposure to cognitively challenging activities designed to reduce fear and build self-efficacy. A mental health therapist specializing in behavioral pain management can help us overcome cogniphobia. We have enough to think about without being fearful of thinking itself.

See more helpful articles:

Anxiety Disorders Associated with Migraine Disease

Catastrophizing in Chronic Migraine

The Basics of Cognitive Behavioral Therapy for Migraine

Sources: Martelli M, MacMillan P, Grayson R. Kinesiophobia and Cogniphobia: Avoidance Conditioned Pain Related Disability. Archives of Clinical Neuropsychology. 1999;14(8):804. DOI: 10.1093/arclin/14.8.804.

Seng E,  Klepper; J. Development of the Cogniphobia Scale for Headache Disorders (CS-HD): A Pilot Study. Psychological Assessment. 2017. Advance online publication. DOI:10.1037/pas0000432.

Spickard B. Pain-Related Fear and Cognitive Performance in Recurrent Headache. Diss. Ohio U, 2011.