Psychiatric disorders that are comorbid with headache may complicate differential diagnosis, affect adherence to treatment regimens, increase the risk of medication overuse, and transform migraine from episodic to chronic. Anxiety disorders are the most common psychiatric comorbidity in headache and are often accompanied by anxiety sensitivity.
Previous studies have shown that anxiety sensitivity predicts fear of pain and maladaptive avoidance behaviors in headache patients. In two recent studies coauthored by Todd Smitherman, PhD, Assistant Professor of Clinical Psychology at the University of Mississippi, high anxiety sensitivity was associated with more frequent and disabling headaches, as well as greater susceptibility to headache triggers, in a sample of undergraduate participants with headache.
This important research suggests that behavioral interventions that target anxiety sensitivity may be helpful in the management of headache pain. These interventions could allow neurologists to move away from a trigger-avoidance model to one of graduated exposure, thus enabling more effective trigger management. High anxiety sensitivity may also be a factor in the development of medication overuse headache and could be an area ripe for investigation. Future research should involve treatment-seeking samples and use a larger sample of migraineurs with aura. The higher psychiatric comorbidity among migraineurs with aura may be related in part to anxiety sensitivity and its biologic underpinnings. Adding and evaluating treatments for anxiety sensitivity will be important for future research.
—Steven M. Baskin, PhD
Codirector, New England Center for Headache