Subjective distress accompanying headache attacks: evidence for a cognitive shift.

This study examined the nature of the cognitions experienced by chronic headache sufferers during headache episodes and assessed whether these cognitions were differentially related to illness behavior and to symptom properties of headache attacks. The data were examined both in terms of headache severity and in terms of the muscle contraction-migraine dichotomy. Forty-four headache patients monitored, with an open-ended assessment format, the thoughts and feelings experienced prior to and during episodes of head pain. The majority of patient responses could reliably be placed into 1 of 2 categories: (a) stress-related cognitions and (b) disorder-related cognitions. The percentage of headache-related thoughts and feelings correlated significantly with several indices of headache severity, including intensity of pain, quality of pain, length of headache attacks, and presence of early morning onset. Further significance to these findings was added by demonstrating that the patients who predominantly reported disorder-related cognitions also displayed a tendency to deny life problems not related to pain. The data were taken as support for the hypothesis that chronic headache disorders of increased severity are accompanied by a cognitive shift whereby the patient's primary concern moves from situational and interpersonal stress to distress associated with the disorder itself.