Behavioural management of the triggers of recurrent headache: Avoidance versus coping

The standard clinical advice for individuals who suffer from recurrent headaches is that ‘the best way to prevent headaches is to avoid the triggers’. There is a plausible argument that such advice may be counter to the interests of headache suffers as it could lead to increased sensitisation and decreased tolerance of headache triggers and therefore more headaches. Research results suggest that it should be possible to increase individual’s tolerance of headache triggers through prolonged exposure for desensitisation or providing exposure as an opportunity to practice coping with headache triggers. The proposed study seeks to compare a psychological treatment that advocates avoidance of headache triggers, with a coping approach that uses exposure to triggers (supported by relaxation and cognitive techniques) except where this is not possible or would seem inappropriate. It is predicted that exposure will increase tolerance to headache triggers and lead to fewer headaches in the long term, whereas avoidance may at best provide short term relief. The study results will have important implications for our understanding of how headache disorders can be more effectively managed in the future.