I can’t even begin to tell you how often I see patients who suffer from headaches getting caught in an endless cycle of taking pain pills. Even if the medicine doesn’t actually relieve the pain, patients just want to feel like they are doing something.
A recent article in the Journal of Headache and Pain examines this phenomenon in migraine patients, and dubs it cephalgiaphobia. Although first described in 2007 by Peres and colleagues, this large study looks at the factors and consequences of living in fear of having a migraine headache, or what has also been called pain-panic.
Cephalgiaphobia is the fear of having another headache. It can occur when the patient is pain-free, but is afraid that the next headache is just around the corner. When in such a state, they often preemptively use an analgesic to try and prevent another headache, whether or not it will actually help.
A phobia, as you probably know already, is the abnormal or irrational fear of a specific thing or situation that forces a person to avoid it, despite knowing that it is not dangerous People who suffer from migraine headaches may live in fear, not knowing when the next headache will, for example, keep them from attending their child’s recital. Migraines are common, affecting 36 million Americans—one person in every four households—and these people are more likely to also have problems with anxiety, depression and phobias. Their headaches and, sometimes, their fear of headaches, frequently interfere with their social functioning and ability to work.
In the recent paper, Italian researchers studied 126 patients with chronic migraine headaches and followed them for two years. They developed their own cephalgiaphobia scale by asking four questions:
- When you are feeling well do you ever fear to have a migraine attack?
- Have you ever used painkillers even though you were not having pain just because you were scared of a possible migraine attack?
- Have you ever used a second dose of painkilling drugs just because you feared that the pain would get worse before it actually did?
- Have you ever used painkillers to improve your performances and be more active, although you were not feeling the pain at all?
Unsurprisingly, the more frequently a person had migraine headaches, the higher their cephalgiaphobia score.
Those who suffer from migraines are vulnerable to medication overuse. The more medication they take, the more likely they are to get a headache, and the less likely it is that their anti-migraine medication will work. Medication overuse headaches sound counterintuitive. Though logically, one would think that taking more pain medication would result in less pain, the truth is that you get a “rebound effect.” A common example of the rebound effect is the many people among us who drink coffee all day long and then awaken the next morning with a headache that can only be relieved by another cup of coffee. They experience a drop in caffeine levels and their brain “rebounds” by wanting another latte or Red Bull to calm things down.
These over-medicators also had higher cephalgiaphobia scores. Theoretically, patients might start to overuse pain medication sooner, thanks to their phobia. The solution to their problem is also counterintuitive: Doctors must convince them to taper off their self-medicating, so that their headaches will decrease. But this isn’t as easy as it sounds. It is incredibly difficult not to take pain medication—the only thing that just might help abate the pain—when your head is pounding.
Successfully weaning a patient off of pain pills typically takes about two weeks. In some cases, patients will need to be hospitalized or a short period to receive a “cocktail” of medicines that prevents the headaches from becoming intolerable. For those who suffer from cephalgiaphobia and frequent headaches, the answer is not easy, and it is certainly not “take two pain pills and call me in the morning.”