Cogniphobia and neuropsychological functioning in migraine.

OBJECTIVE: Cogniphobia refers to the fear and avoidance of cognitive exertion, believed to cause or exacerbate headache. The objective of the present study was to demonstrate associations between cogniphobia and key fear-avoidance constructs. METHOD: In this cross-sectional study, 72 adults with migraine were recruited from a tertiary headache center. Patients completed the Cogniphobia Scale for Headache Disorders (CS-HD) and a series of self-reported surveys and neuropsychological measures that assessed patient demographics, migraine diagnosis and headache characteristics, current pain severity, emotional state (i.e., anxiety, pain-related fear, and depression), cognitive exertion, and functioning (self-reported disability, self-reported cognitive symptoms, and neuropsychological measures). RESULTS: The CS-HD was associated with greater anxiety (Patient-Reported Outcomes Measurement Information System; PROMIS Anxiety; r = 0.39, p = .001), pain-related fear (PASS-20; ρ = 0.37, p = .002), self-reported cognitive symptoms (ABS; ρ = 0.38, p = .001), self-reported headache disability (HDI; r = 0.28, p = .022), and depression (PROMIS Depression; r = 0.25, p = .039). The CS-HD was also associated with lower scores on neuropsychological measures of semantic fluency (Animal Naming; r = -0.29, p = .015), visual immediate recall memory (RCFT Immediate Recall; r = -0.27, p = .027), visual delayed recall memory (RCFT Delayed Recall; r = -0.36, p = .002), and visual recognition memory (RCFT Recognition; r = -0.42, p < .001), with comparable findings when adjusting for depression and anxiety. CONCLUSION: This study demonstrated associations between cogniphobia and key fear-avoidance constructs. Fear-avoidance constructs, such as cogniphobia, are important constructs to consider when evaluating migraine and neuropsychological functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychological Factors Associated With Chronic Migraine and Severe Migraine-Related Disability: An Observational Study in a Tertiary Headache Center.

OBJECTIVE: To evaluate the relationships among modifiable psychological factors and chronic migraine and severe migraine-related disability in a clinic-based sample of persons with migraine. BACKGROUND: Evidence evaluating relationships between modifiable psychological factors and chronic migraine and severe migraine-related disability is lacking in people with migraine presenting for routine clinical care. METHODS: Adults with migraine completed surveys during routinely scheduled visits to a tertiary headache center. Participants completed surveys assessing chronic migraine (meeting criteria for migraine with ≥15 headache days in the past month), severe migraine disability (Migraine Disability Assessment Scale score ≥ 21), and modifiable psychological factors (depressive symptoms [Patient Health Questionnaire-9], anxious symptoms [Generalized Anxiety Disorder-7], Pain Catastrophizing Scale and Headache Specific Locus of Control). Logistic regression evaluated relationships between modifiable psychological factors and chronic migraine and severe migraine disability. RESULTS: Among 90 eligible participants the mean age was 45.0 (SD = 12.4); 84.8% were women. One-third (36.0%) met study criteria for chronic migraine; half of participants (51.5%) reported severe migraine-related disability. Higher depressive symptoms (OR = 1.99, 95% CI = 1.11, 3.55) and chance HSLC (OR = 1.85, 95% CI = 1.13, 1.43) were associated with chronic migraine. Higher depressive symptoms (OR = 3.54, 95%CI = 1.49, 8.41), anxiety symptoms (OR = 3.65, 95% CI = 1.65, 8.06), and pain catastrophizing (OR = 1.95, 95% CI = 1.14, 3.35), were associated with severe migraine-related disability. CONCLUSIONS: Psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance locus of control were associated with chronic migraine. This study supports the need for longitudinal observational studies to evaluate the relationships among naturalistic variation in psychological factors, migraine-related disability, and migraine chronification.

Development of the Cogniphobia Scale for Headache Disorders (CS-HD): A pilot study.

Cogniphobia refers to the specific fear and avoidance of cognitive exertion, which is believed to precipitate or exacerbate headache. This parallels a well-documented phenomenon, kinesiophobia (fear of movement), in chronic pain. The existing measure of cogniphobia (C-Scale) was developed in persons with posttraumatic headache, and item content may not generalize to the broader headache population. This study aimed to develop and begin the initial examination of the psychometrics of a novel measure of cogniphobia for headache disorders: The Cogniphobia Scale for Headache Disorders (CS-HD). Candidate CS-HD items were developed through content analysis, patient evaluation, and peer debriefing. Eighty adults with migraine recruited from a headache center completed 23 candidate items for the CS-HD and surveys of demographics, anxiety, and headache locus of control. A series of dimensionality analyses identified a single component, composed of 15 items, which accounted for 54.05% of the variance in the CS-HD items. The CS-HD demonstrated high internal consistency in this sample (α = 0.94). Preliminary convergent validity analyses found CS-HD total scores were positively associated with anxiety (ρ = .37, p = .001) and locus of control (internal, r = .45, p < .001; chance, r = .30, p = .009). This study provides initial evidence supporting the use of the CS-HD to evaluate cogniphobia in people with headache. (PsycINFO Database Record