Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy

Martin, Paul R.; MacLeod, Colin

doi:10.1016/j.cpr.2009.05.002

Cited by 171Migraine and Headache StudiesMusculoskeletal pain and rehabilitationTraumatic Brain Injury Research

Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy

Martin, Paul R., MacLeod, Colin·2009·Clinical Psychology Review

DOI 10.1016/j.cpr.2009.05.002

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Abstract

The standard clinical advice for individuals who suffer from recurrent headaches is that the best way to prevent headaches is to avoid the triggers. This review challenges that advice from a number of perspectives, including: that the advice is given in a theoretical vacuum; it is associated with practical problems; and it is not evidence-based. The review considers cognate literatures on stress, negative affect, and chronic pain that advocate approach/confront strategies over avoidance strategies. It is suggested that advice to avoid triggers could result in maintenance of the capacity of the trigger to precipitate headaches or even a sensitization process whereby tolerance diminishes. As anxiety researchers have investigated extensively the issue of how stimuli acquire and lose their capacity to elicit fear, this literature is explored to draw inferences for headache triggers. The review concludes with suggestions concerning etiology of chronic headache and associated management implications, and directions for future research. It argues that the philosophy of 'avoidance of triggers' should be replaced with 'coping with triggers,' as the latter includes both avoidance and approach/confront strategies involving exposure to triggers.

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Trigger-avoidance effectiveness is especially unsupported when applied inflexibly to all triggers and at the expense of valued living.
“especially when this is applied inflexibly to all triggers and at the expense of valued living.45”
From Acceptance and Commitment Therapy for Primary Headache Sufferers: A Randomized Controlled Trial of Efficacy (2021) · cites this paper as [45]
Research and this study's findings do not show differential psychosocial effects between those with migraines and tension-type headache.
“although, research and this studies’ findings do not show differential psychosocial effects between those with migraines and tension-type headache,44”
From Acceptance and Commitment Therapy for Primary Headache Sufferers: A Randomized Controlled Trial of Efficacy (2021) · cites this paper as [45]

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EFNS guideline on the treatment of tension‐type headache – Report of an EFNS task force
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Sleep and Headache
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Psychosocial Factors of Relevance to Sex and Gender Studies in Headache
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Evaluation of the Fear Avoidance Behavior after Traumatic Brain Injury Questionnaire
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Color and Spatial Frequency Are Related to Visual Pattern Sensitivity in Migraine
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Headache Triggers as Surprise
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Headache Trigger Sensitivity and Avoidance after Mild Traumatic Brain Injury
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Work-Related Psychosocial and Organizational Risk Factors for Headache
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Eye movements during visual search for emotional faces in individuals with chronic headache
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Fear, Avoidance, and Disability in Headache Disorders
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Authors: Martin, P. R., & MacLeod, C.
Affiliations: Monash Medical Centre (AU)
The University of Western Australia (AU)
Corresponding author: Martin, Paul R.
ORCID: Martin, Paul R.
MacLeod, Colin
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2009-08
Volume: 29
Issue: 6
Pages: 483-495
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2009.05.002
OpenAlex: W1974134796
Cited by: 171
References: 163
Citations by year: 2026: 4 · 2025: 9 · 2024: 5 · 2023: 6 · 2022: 8 · 2021: 9 · 2020: 13 · 2019: 12 · 2018: 7 · 2017: 12 · 2016: 14 · 2015: 10 · 2014: 12 · 2013: 17 · 2012: 13
FWCI: 1.39
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
UWA Profiles and Research Repository (UWA) (submittedVersion)
Griffith Research Online (submittedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Migraine and Headache Studies
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords: headache triggers, trigger avoidance, recurrent headache, chronic headache, avoidance strategies, stress, negative affect, chronic pain, sensitization, anxiety, fear acquisition, headache prevention
MeSH terms: Adaptation, Psychological, Affect, Alcohol Drinking, Anxiety Disorders, Avoidance Learning, Chronic Disease, Desensitization, Psychologic, Diet, Humans, Hunger, Menstruation, Pain, Sleep Wake Disorders, Stress, Psychological, Weather, Headache Disorders, Pain Management

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Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy

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