Fear of Headaches

What it produces is a distinctive behaviour. Sufferers tend to overuse analgesic medication, taking it preemptively to head off a headache or migraine that has not yet arrived. That is why doctors treating this often do not prescribe pain medication at all and prescribe psychiatric medication instead. The drug the patient wants is the mechanism of the problem. In behaviour it is the inverse of pharmacophobia, which refuses the drug, and both interfere with treatment.

People with it usually have a history of frequent migraines behind them, which makes the fear an accurate prediction misapplied to a moment when it does not hold. That gives it a narrower object than algophobia and a stranger timing, since the pain is anticipated during its absence.

Why cephalalgiaphobia prevalence cannot be measured

Very little is known about how common it is, because there are few reported cases to analyse. The reason for that is worth stating: someone in this position is unlikely to recognise that their medication use is a phobic response rather than a sensible precaution, which is the difficulty Health Anxiety presents too.

One study, reported in Cephalalgiaphobia: a possible specific phobia of illness, followed 12 patients and found a particular avoidance behaviour among people with chronic migraine attacks. The prevalence within that study population was 60 per cent, and the subjects met the DSM-IV diagnostic criteria for a specific phobia, even where the phobia was not specifically this one.

What doctors prescribe for cephalalgiaphobia instead

The medications used are the ones prescribed for anxiety, depression and other phobias:

• selective serotonin reuptake inhibitors
• tricyclic antidepressants
• benzodiazepines

Psychotherapy of various kinds runs alongside them.

The non-pharmacological option is unusual for this catalogue. Acupuncture has been shown to reduce fear of headache pain, and work on acupuncture used for headache before neurological referral records positive benefits in relieving the headache symptoms of the patients studied.

What Peres found in his migraine patients

Mario Peres and colleagues coined the term in its clinical form in a paper published in February 2007, describing twelve migraine patients with phobic avoidance built around their attacks and classifying it as a specific phobia of illness. Every one of the twelve was a woman, their mean age was 42, eleven had chronic migraine, and all of them overused acute medication.

The paper's opening observation is the reason it exists: phobias are reported by half of chronic migraine patients, and phobic avoidance tied specifically to the fear of a headache had never been adequately described. A condition affecting half a clinic population had no name for its commonest form.

Whether cephalalgiaphobia makes migraine more frequent

A prospective cohort study followed 126 consecutive migraine patients referred to a tertiary headache centre, measuring cephalalgiaphobia with a four-item questionnaire at baseline and again two years later.

Three results, all at a p value below 0.001. Moderate to high migraine frequency went with a higher risk of the fear. Chronic migraineurs who overused medication scored higher than those who did not. And patients whose migraine frequency had increased over the two years had higher cephalalgiaphobia scores.

The authors' conclusion is that cephalalgiaphobia may be a feature of high-frequency migraine and may play a part in chronicisation. That is the loop stated as a finding rather than as a suspicion: the fear of the headache leads to taking the painkiller early, the early painkiller produces medication overuse, and medication overuse turns episodic migraine into chronic migraine. What was feared arrives because it was feared.

What cervico-cephalalgiaphobia does to manual therapy

A Dutch study proposed a subtype for patients with cervicogenic headache, headache arising from the neck, and called it cervico-cephalalgiaphobia. An expert group agreed a definition and narrowed ten candidate indicators to eight, and thirty-six manual physical therapists supplied data on 46 patients.

The indicators that scored often or always describe a treatment pattern rather than a feeling:

• short-term positive results from previous manual therapy
• a shorter interval between sessions
• fear of locked facet joints in the neck
• more frequent manipulation
• fear of an increase in headaches

The indicator that scored never, substantially, was long-term positive results from previous manual therapy.

Read as a sequence, that is a patient returning more and more often for a treatment that helps briefly and does not hold, driven by a fear of what the neck is doing. It is the same loop as the analgesic one with a different intervention in the middle.

How cephalalgiaphobia survived a deletion proposal

Wikipedia's article on cephalalgiaphobia was proposed for deletion and the proposal was declined in June 2009, with the editor noting eleven hits on Google Scholar, that it is definitely not a neologism, and that the sources meet the reliability standard.

That is a low bar cleared, and the article is still rated start-class and low-importance. For a condition present in a substantial share of one clinic population, the encyclopedic footprint is small.