Headache triggers: To avoid or not to avoid, that is the question

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Abstract
Traditional clinical advice in the management of headaches is to avoid trigger factors. There is a danger, however, that avoidance of triggers results in a sensitisation process whereby tolerance for the triggers decreases, in a manner analogous to increments in anxiety arising from avoidance of anxiety-eliciting stimuli. Reported here are six single-case experiments in which the aim was to desensitise headache sufferers to an experimentally validated trigger, namely “visual disturbance”. The results demonstrated that repeated, prolonged exposure to a headache trigger led to desensitisation with participants experiencing less visual disturbance, less negative affect and less head pain in response to the trigger. These findings have theoretical significance as they speak to the issue of the aetiology of chronic headache, and practical significance as they suggest that a key aspect of current management may contribute to the disorder becoming worse rather than better.

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