The headache triggers sensitivity and avoidance questionnaire: establishing the psychometric properties of the questionnaire
Abstract
OBJECTIVE: The purpose of this study was to evaluate the psychometric properties of the newly developed Headache Triggers Sensitivity and Avoidance Questionnaire (HTSAQ) designed to measure variables relating to the Trigger Avoidance Model of Headaches. BACKGROUND: The Trigger Avoidance Model of Headaches proposes that one pathway to developing a primary headache disorder is through the avoidance of headache triggers, resulting in an increase in trigger potency through sensitization. Conversely, prolonged exposure to certain triggers may reduce a potential trigger's ability to precipitate a headache. This model has led to an alternative approach to trigger management being proposed called Learning to Cope with Triggers, which advocates the desensitization of certain headache triggers through controlled exposure, while supporting avoidance of those triggers that are detrimental to health and wellbeing. To be able to evaluate predictions based on the Trigger Avoidance Model of Headaches and to investigate the effectiveness of Learning to Cope with Triggers, psychometrically sound measures of trigger sensitivity and trigger avoidance are needed. METHOD: A convenience sample of 376 participants (87.5% female; 64.1% European descent) was recruited for the online study which consisted of a battery of measures including the HTSAQ, Brief Headache Screen, Pain Anxiety Symptoms Scale, Pain Sensitivity Questionnaire, Chronic Pain Acceptance Questionnaire, and demographic items. With an interval of 2-6 weeks, a subsample of participants (n = 201) completed the HTSAQ for a second time. The mean age of the sample was 31.4 years (SD = 12.8). The most common headache diagnoses (based on the Brief Headache Screen) were migraine (chronic = 62; episodic = 160), followed by medication-overuse headache (n = 87). The remaining participants (n = 67) were diagnosed as having episodic less severe headache (most likely tension-type headache). RESULTS: Reliability was assessed through internal consistency and test-retest reliability over a period of 2-6 weeks, and both were excellent (alpha > .80). Strong construct validity was demonstrated by the measure's scale scores being significantly correlated in theoretically consistent ways with the Pain Sensitivity Questionnaire, Pain Anxiety Symptoms Scale, and Chronic Pain Acceptance Questionnaire. As the Trigger Avoidance Model of Headaches would predict, correlations between the HTSAQ Sensitivity scales and the Avoidance scale were strong (P < .001), and participants with chronic migraine had significantly higher HTSAQ scores than those with episodic headaches. CONCLUSION: The findings support the use of the HTSAQ as a valid and reliable tool for assessing sensitivity to headache triggers and avoidance of headache triggers. Further research examining the factor structure of the HTSAQ is warranted.
Integrity signals
Registry
Cites
Statistics
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?
The CPAQ showed good internal consistency in a sample of persons with headache (Cronbach's α = 0.84).
“The CPAQ includes 20 items and showed good internal consistency in a sample of persons with headache (Cronbach's α = 0.84) (39).”
From Efficacy of Cognitive-Behavioral Therapy for the Prophylaxis of Migraine in Adults: A Three-Armed Randomized Controlled Trial (2022) · cites this paper as [39]
The four HTSAQ scales have good internal consistency (Cronbach's α = 0.83 to 0.86).
“All four scales have a good internal consistency (Cronbach's α = 0.83 to 0.86) (39).”
From Efficacy of Cognitive-Behavioral Therapy for the Prophylaxis of Migraine in Adults: A Three-Armed Randomized Controlled Trial (2022) · cites this paper as [39]
Cites
Tabachnick, B. G., & Fidell, L. S. (1983) · Cited by 79,888 · see citing works
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007) · Behavior Research Methods · doi:10.3758/bf03193146 · Cited by 65,971 · see citing works
Making sense of cronbach’s alpha.
Tavakol, M., & Dennick, R. (2011) · International Journal of Medical Education · doi:10.5116/ijme.4dfb.8dfd · Cited by 15,126 · see citing works
Flesch, R. (1948) · Journal of Applied Psychology · doi:10.1037/h0057532 · Cited by 5,391 · see citing works
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 · see citing works
The Technique of Clear Writing.
Gunning, R. C. (1968) · CERN Document Server (European Organization for Nuclear Research) · Cited by 1,675 · see citing works
Outline of a fear-avoidance model of exaggerated pain perception--I.
Lethem, J., Slade, P. D., Troup, J. D. G., & Bentley, G. (1983) · Behaviour Research and Therapy · doi:10.1016/0005-7967(83)90009-8 · Cited by 1,327 · see citing works
Acceptance of chronic pain: component analysis and a revised assessment method
McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004) · Pain · doi:10.1016/j.pain.2003.10.012 · Cited by 1,101 · see citing works
A computer readability formula designed for machine scoring.
Coleman, M., & Liau, T. L. (1975) · Journal of Applied Psychology · doi:10.1037/h0076540 · Cited by 1,056 · see citing works
The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain
McCracken, L. M., Zayfert, C., & Gross, R. T. (1992) · Pain · doi:10.1016/0304-3959(92)90113-p · Cited by 950 · see citing works
The Triggers or Precipitants of the Acute Migraine Attack
Kelman, L. (2007) · Cephalalgia · doi:10.1111/j.1468-2982.2007.01303.x · Cited by 871 · see citing works
Neurological Disorders. Public Health Challenges
Vardi, G., & Merrick, J. (2007) · Journal of Policy and Practice in Intellectual Disabilities · doi:10.1111/j.1741-1130.2007.00122.x · Cited by 766 · see citing works
A short version of the Pain Anxiety Symptoms Scale (PASS-20): Preliminary development and validity
McCracken, L. M., & Dhingra, L. (2002) · Pain Research and Management · doi:10.1155/2002/517163 · Cited by 644 · see citing works
Evaluating quality-of-life and health status instruments: development of scientific review criteria
Lohr, K. N., Aaronson, N. K., Alonso, J., Burnam, M. A., Patrick, D. L., Perrin, E. B., & Roberts, J. S. (1996) · Clinical Therapeutics · doi:10.1016/s0149-2918(96)80054-3 · Cited by 591 · see citing works
Smith, E. A., & Senter, R. J. (1967) · PubMed · Cited by 544 · see citing works
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 · see citing works
The conditioning model of neurosis
Eysenck, H. J. (1979) · Behavioral and Brain Sciences · doi:10.1017/s0140525x00061653 · Cited by 396 · see citing works
Ruscheweyh, R., Marziniak, M., Stumpenhorst, F., Reinholz, J., & Knecht, S. (2009) · Pain · doi:10.1016/j.pain.2009.06.020 · Cited by 364 · see citing works
Precipitating and Aggravating Factors of Migraine Versus Tension‐type Headache
Spierings, E. L. H., Ranke, A. H., & Honkoop, P. C. (2001) · Headache The Journal of Head and Face Pain · doi:10.1046/j.1526-4610.2001.041006554.x · Cited by 354 · see citing works
Readability formulas: Cautions and criteria
Meade, C. D., & Smith, C. F. (1991) · Patient Education and Counseling · doi:10.1016/0738-3991(91)90017-y · Cited by 275 · see citing works
Friedman, D. I., & Dye, T. (2009) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2009.01443.x · Cited by 210 · see citing works
Cephalic and extracephalic pressure pain thresholds in chronic tension-type headache
Schoenen, J. E., Bottin, D., Hardy, F., & Gerard, P. (1991) · Pain · doi:10.1016/0304-3959(91)90198-7 · Cited by 205 · see citing works
A new unified treatment approach for emotional disorders based on emotion science
Moses, E. B., & Barlow, D. H. (2006) · Current Directions in Psychological Science · doi:10.1111/j.0963-7214.2006.00425.x · Cited by 197 · see citing works
An Analysis of Migraine Triggers in a Clinic‐Based Population
Andress‐Rothrock, D., King, W., & Rothrock, J. F. (2010) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2010.01753.x · Cited by 182 · see citing works
Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy
Martin, P. R., & MacLeod, C. (2009) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.05.002 · Cited by 171 · see citing works
Self-citationValidation of the Pain Sensitivity Questionnaire in chronic pain patients
Ruscheweyh, R., Verneuer, B., Dany, K., Marziniak, M., Wolowski, A., Colak-Ekici, R., Schulte, T. L., Bullmann, V., Grewe, S., Gralow, I., et al. (2012) · Pain · doi:10.1016/j.pain.2012.02.025 · Cited by 167 · see citing works
Alcohol and migraine: trigger factor, consumption, mechanisms. A review
Panconesi, A. (2008) · The Journal of Headache and Pain · doi:10.1007/s10194-008-0006-1 · Cited by 163 · see citing works
A meta‐analytic review of the association between anxiety sensitivity and pain
Ocañez, K. L. S., McHugh, R., & Otto, M. W. (2010) · Depression and Anxiety · doi:10.1002/da.20681 · Cited by 160 · see citing works
An Exploration of the Psychometric Properties of the PASS-20 With a Nonclinical Sample
Abrams, M. P., Carleton, R. N., & Asmundson, G. J. G. (2007) · Journal of Pain · doi:10.1016/j.jpain.2007.06.004 · Cited by 140 · see citing works
Behavioral Management of Migraine Headache Triggers: Learning to Cope with Triggers
Martin, P. R. (2010) · Current Pain and Headache Reports · doi:10.1007/s11916-010-0112-z · Cited by 139 · see citing works
Self-citationWicksell, R. K., Olsson, G. L., & Melin, L. (2009) · European Journal of Pain · doi:10.1016/j.ejpain.2008.09.003 · Cited by 135 · cited 1× · see citing works
“Factor analytic studies have confirmed a 2-factor structure supporting these subscales.(41,42) Higher scores for each of the scales is indicative of greater acceptance of chronic pain.”
BackgroundBehavioral management of the triggers of recurrent headache: A randomized controlled trial
Martin, P. R., Reece, J., Callan, M., MacLeod, C., Kaur, A., Gregg, K., & Goadsby, P. J. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.07.002 · Cited by 116 · see citing works
Self-citationFear-Avoidance Models of Chronic Pain: An Overview
Asmundson, G. J. G., Norton, P. J., & Vlaeyen, J. W. S. (2004) · doi:10.1093/oso/9780198525141.003.0001 · Cited by 116 · see citing works
Towards improved migraine management: Determining potential trigger factors in individual patients
Peris, F., Donoghue, S., Torres, F., Mian, A., & Wöber, C. (2016) · Cephalalgia · doi:10.1177/0333102416649761 · Cited by 107 · see citing works
Gaul, C., Visscher, C. M., Bhola, R., Sorbi, M. J., Galli, F., Rasmussen, A. V., & Jensen, R. (2011) · The Journal of Headache and Pain · doi:10.1007/s10194-011-0364-y · Cited by 101 · see citing works
Karlı, N., Zarifoğlu, M., Çalişir, N., & Akgöz, S. (2005) · Cephalalgia · doi:10.1111/j.1468-2982.2005.00880.x · Cited by 100 · see citing works
Noise as a Trigger for Headaches: Relationship Between Exposure and Sensitivity
Martin, P. R., Reece, J., & Forsyth, M. R. (2006) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2006.00468.x · Cited by 94 · see citing works
Self-citationProphylactic Drug Treatment of Migraine in Children and Adolescents: An Update
Tajti, J., Szok, D., Csáti, A., & Vécsei, L. (2015) · Current Pain and Headache Reports · doi:10.1007/s11916-015-0536-6 · Cited by 83 · see citing works
How do trigger factors acquire the capacity to precipitate headaches?
Martin, P. R. (2001) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(00)00032-2 · Cited by 79 · see citing works
Self-citationHow reliable is computerized assessment of readability?
Mailloux, S. L., Johnson, M. E., Fisher, D. G., & Pettibone, T. J. (1995) · PubMed · Cited by 77 · see citing works
(2001) · Oxford University Press eBooks · doi:10.1093/med:psych/9780195130447.001.0001 · Cited by 74 · see citing works
Managing headache triggers: Think ‘coping’ not ‘avoidance’
Martin, P. (2009) · Cephalalgia · doi:10.1111/j.1468-2982.2009.01989.x · Cited by 68 · see citing works
Self-citationStress and Primary Headache: Review of the Research and Clinical Management
Martin, P. R. (2016) · Current Pain and Headache Reports · doi:10.1007/s11916-016-0576-6 · Cited by 66 · see citing works
Self-citationMeasuring experiential avoidance in adults: the Avoidance and Fusion Questionnaire
Schmalz, J. E., & Murrell, A. R. (2010) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100908 · Cited by 65 · see citing works
Rapid and Sensitive Paradigm for Screening Patients With Headache in Primary Care Settings
Maizels, M., & Burchette, R. J. (2003) · Headache The Journal of Head and Face Pain · doi:10.1046/j.1526-4610.2003.03088.x · Cited by 56 · see citing works
[Precipitating factors of migraine attacks in patients with migraine without aura].
Ierusalimschy, R., & Filho, P. F. M. (2002) · PubMed · Cited by 45 · see citing works
Headache triggers: To avoid or not to avoid, that is the question
Martin, P. R. (2000) · Psychology and Health · doi:10.1080/08870440008405582 · Cited by 44 · see citing works
Self-citationStress as a trigger for headaches: Relationship between exposure and sensitivity
Martin, P. R., Lae, L., & Reece, J. (2007) · Anxiety Stress & Coping · doi:10.1080/10615800701628843 · Cited by 37 · see citing works
Self-citationChronic pain: An experimental analysis of the effects of exposure
Philips, H. C., & Jahanshahi, M. (1985) · Behaviour Research and Therapy · doi:10.1016/0005-7967(85)90006-3 · Cited by 35 · see citing works
Clinical presentation and treatment of migraine
Skaer, T. L. (1996) · Clinical Therapeutics · doi:10.1016/s0149-2918(96)80004-x · Cited by 30 · see citing works
Results of Screening With the Brief Headache Screen Compared With a Modified IDMigraine TM
Maizels, M., & Houle, T. T. (2007) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2007.00946.x · Cited by 19 · see citing works
Leone, M., Vila, C., & McGown, C. C. (2010) · Expert Review of Neurotherapeutics · doi:10.1586/ern.10.119 · Cited by 19 · see citing works
Precipitating factors of migraine attacks in patients with migraine with and without aura
Denız, O., Aygül, R., Koçak, N., Orhan, A., & Kaya, M. (2004) · The Pain Clinic · doi:10.1163/1568569042664459 · Cited by 15 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Fear, Avoidance, and Disability in Headache Disorders
Rogers, D. G., Protti, T. A., & Smitherman, T. A. (2020) · Current Pain and Headache Reports · doi:10.1007/s11916-020-00865-9 · Cited by 34 · see citing works
Klan, T., Gaul, C., Liesering-Latta, E., Both, B., Held, I., Hennemann, S., & Witthöft, M. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.852616 · Cited by 22 · see citing works
An Integrative Cognitive Behavioral Therapy Program for Adults With Migraine: A Feasibility Study
Klan, T., Liesering‐Latta, E., Gaul, C., Martin, P. R., & Witthöft, M. (2019) · Headache: The Journal of Head and Face Pain · doi:10.1111/head.13532 · Cited by 21 · see citing works
Self-citation
- Authors
- Kubik, S. U., & Martin, P. R.
- Affiliations
- Griffith University (AU)
- Corresponding author
- Kubik, Sonja U.
- Venue
- Headache The Journal of Head and Face Pain
- Publisher
- Wiley
- Published
- 2016-10-18
- Volume
- 57
- Issue
- 2
- Pages
- 236-254
- ISSN
- 0017-8748 (ISSN-L)
- 1526-4610
- OpenAlex
- W2537795742
- Cited by
- 27
- References
- 53
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 6 · 2019: 5 · 2018: 1 · 2017: 1
- FWCI
- 2.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Headache The Journal of Head and Face Pain (publishedVersion)
- PubMed (publishedVersion)
- 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 › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Keywords
- trigger avoidance, trigger sensitivity, desensitization, chronic migraine, medication overuse headache, tension-type headache, primary headache, psychometric validation, test-retest reliability, construct validity, internal consistency, pain sensitivity, anxiety, chronic pain acceptance
- MeSH terms
- Adult, Anxiety, Avoidance Learning, Cross-Sectional Studies, Female, Follow-Up Studies, Headache, Humans, Male, Models, Neurological, Pain Measurement, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, Socioeconomic Factors, Reproducibility of Results, Internet, Headache Disorders
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
