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Published on: June 2, 2014
Migraine is associated with altered approach-avoidance decision processing: a case control study
Sebastian Evers1,2, Andrea Kübler3,4, Claudia Sommer5,6
1Department of Neurology, University Hospital Würzburg, Würzburg, Germany. sebastian.evers@posteo.de.
The Journal of Headache and Pain
|July 17, 2026
Summary
Individuals with migraine show altered decision-making, with longer decision times and impaired regulatory control when facing triggers. Current confrontational strategies do not effectively modulate these migraine-related cognitive processes.
Area of Science:
- Neuroscience
- Cognitive Psychology
- Clinical Neurology
Background:
- Migraine management traditionally focuses on trigger avoidance, but confrontational coping strategies are gaining traction.
- Understanding how migraine patients process trigger information in approach-avoidance scenarios is key for effective interventions.
Purpose of the Study:
- To investigate decision-making processes in individuals with migraine when exposed to trigger-related stimuli.
- To assess neurophysiological correlates of approach-avoidance behavior in migraine.
Main Methods:
- Participants (migraine patients and controls) completed an adapted virtual T-maze task with trigger and neutral stimuli.
- Behavioral data (decision time, initial movement response) and neurophysiological data (high-density EEG: frontal alpha asymmetry, frontal midline theta, functional connectivity) were collected.
Main Results:
- Migraine patients exhibited prolonged decision times, especially in avoidance and high-conflict situations, suggesting increased cognitive load.
- Indirect trigger confrontation did not significantly alter behavior or neurophysiological measures.
- EEG analyses revealed reduced frontal alpha asymmetry and frontal midline theta, alongside altered functional connectivity, indicating impaired regulatory control and heightened neural excitability in migraine.
Conclusions:
- Migraine is linked to altered approach-avoidance decision-making with increased cognitive demand and deficient regulatory control.
- The tested indirect trigger confrontation strategy was insufficient to modify these processes.
- Further research should explore simpler paradigms and neuromodulation techniques targeting specific EEG markers.
