Headache fear

A prospective study of migraine patients seen at the office, over six months, was conducted to ascertain the prevalence and intensity of headache fear. With patients' help a questionnaire, with 14 questions and a maximum score of 50, was developed and refined. A total of 100 patients with episodic migraines (< 15 headache days/month) and another 100 patients with intractable migraines (> or = 15 headache days/month) were inducted. Fifty controls were selected from office patients who, on routine system review, were found to have migraine headaches but had never consulted a physician about them. The average fear score of the control group was 3/50 (range: 0 to 9), and only 2% felt a strong compulsion to take analgesics when headaches began. Based on that, headache fear was defined as a score of 10 or more. The average fear score of the episodic group was 12/50 (range: 0 to 43), 49% had a fear score of > or = 10, and 38% felt a strong compulsion to take analgesics. The average fear score of the intractable group was 19/50 (range: 0 to 46), 73% had a fear score of > or = 10, and 60% felt a strong compulsion to take analgesics. The average number of analgesic tablets taken per month in the control group was 7 (range: 0-150), in the episodic group 22 (range: 0-120), and in the intractable group 139 (range: 0-400). The three groups were comparable as far as age, gender, and migraine years. The frequency of migraines per month was 3 (range: 0-30) in the control group, 6 (range: 0-14) in the episodic group, and 29 (range: 15-30) in the intractable group. As empirically defined, headache fear is common and increases in a statistically significant manner across the three migraine groups (control-episodic-intractable). I theorize that this fear may reinforce analgesic overuse and interfere with withdrawal efforts. Alloying this fear from the outset might provide patients with the support and reassurance needed for analgesic withdrawal, which is often necessary for recovery.