The DOI matches its Crossref record; 159 of the 163 references it cites were found in a registry or an index.
Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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]
In the citing paper
“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]
Citations
Cites
(1993) · Cited by 7,136
Cognitive-Behavioral Treatment of Borderline Personality Disorder
Cary, G. L. (1994) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1994.48.1.155 · Cited by 6,299
Handbook of Psychotherapy and Behavior Change
Garfield, S. L., Bergin, A. E., & Dryden, W. (1987) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.1.4.264a · Cited by 3,998
(2001) · Cited by 3,666
Psychotherapy by reciprocal inhibition
Wolpe, J. (1968) · Pavlovian Journal of Biological Science · doi:10.1007/bf03000093 · Cited by 3,406
Psychotherapy by Reciprocal Inhibition
Masserman, J. H. (1958) · Archives of Neurology And Psychiatry · doi:10.1001/archneurpsyc.1958.02340090135025 · Cited by 3,087
Handbook of Psychotherapy and Behavior Change
Sanford, E. F. (1988) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1988.42.1.153 · Cited by 2,586
The global burden of headache: A documentation of headache prevalence and disability worldwide
Stovner, L., Hagen, K., Jensen, R., Katsarava, Z., Lipton, R., Scher, A., Steiner, T., & Zwart, J.-A. (2007) · Cephalalgia · doi:10.1111/j.1468-2982.2007.01288.x · Cited by 2,444
Prevalence and Burden of Migraine in the United States: Data From the American Migraine Study II
Lipton, R. B., Stewart, W. F., Diamond, S., Diamond, M. L., & Reed, M. (2001) · Headache: The Journal of Head and Face Pain · doi:10.1046/j.1526-4610.2001.041007646.x · Cited by 2,268
Measuring experiential avoidance: A preliminary test of a working model
Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., et al. (2004) · The Psychological Record · doi:10.1007/bf03395492 · Cited by 2,140
Research works printed but not linked: 10
- Abramson, 1995, Is allergen immunotherapy effective in asthma?, American Journal of Respiratory and Critical Care Medicine, 151, 969
- Diamond, 1979, Headache, American Academy of Family Physicians, 6
- Ehde, 1992, Stress and headache: Comparisons of migraine, tension, and headache-free subjects, Headache Quarterly, Current Treatment and Research, 3, 54
- Gotzsche, 2003, House dust mite control measures for asthma (Cochrane Review)
- Marcus, 2003, Chronic headache: The importance of trigger identification, Headache and Pain, 14, 139
- O'Banion, 1981, Dietary control of headache pain, five case studies, Journal of Holistic Medicine, 3, 140
- Radnitz, 1990, A preliminary report of dietary therapy as a treatment for refraction migraine headache, Headache Quarterly, 1, 239
- Savi, 2002, Food and headache attacks, Panminerva Medica, 44, 27
- Scopp, 1992, Headache triggers. Part I, Headache Quarterly, 3, 32
- Smith, 2006, Are changes in cognitive and emotional factors important in improvement in headache impact and quality of life, Headache, 46, 878
Cited by
Sorted by citations
EFNS guideline on the treatment of tension‐type headache – Report of an EFNS task force
Bendtsen, L., Evers, S., Linde, M., Mitsikostas, D., Sandrini, G., & Schoenen, J. E. (2010) · European Journal of Neurology · doi:10.1111/j.1468-1331.2010.03070.x · Cited by 452
Perceived triggers of primary headache disorders: A meta-analysis
Pellegrino, A. B. W., Davis-Martin, R. E., Houle, T. T., Turner, D. P., & Smitherman, T. A. (2018) · Cephalalgia · doi:10.1177/0333102417727535 · Cited by 288
“Indeed, accumulating evidence suggests that the clinical lore of advising headache patients to avoid triggers may inadvertently increase sensitization to some triggers (23), and that training patients in other means of coping with triggers may be a viable management strategy (24), particularly for those that cannot be…”
Dresler, T., Caratozzolo, S., Guldolf, K., Huhn, J.-I., Loiacono, C., Niiberg-Pikksööt, T., Puma, M., Sforza, G., Tobia, A., Ornello, R., et al. (2019) · The Journal of Headache and Pain · doi:10.1186/s10194-019-0988-x · Cited by 253
Schoth, D. E., Nunes, V. D., & Liossi, C. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.09.004 · Cited by 217
Stress and sleep duration predict headache severity in chronic headache sufferers
Houle, T. T., Butschek, R. A., Turner, D. P., Smitherman, T. A., Rains, J. C., & Penzien, D. B. (2012) · Pain · doi:10.1016/j.pain.2012.08.014 · Cited by 188
Metadata
- Authors
- Martin, P. R., & MacLeod, C.
- Affiliations
- Monash Medical Centre (AU)
- The University of Western Australia (AU)
- Corresponding author
- Martin, Paul R.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2009-08
- Volume
- 29
- Issue
- 6
- Pages
- 483-495
- ISSN
- 0272-7358 (ISSN-L)
- 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
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Griffith Research Online (submittedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Migraine and Headache Studies
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Clinical Neurology › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review