Cogniphobia in Migraine: Examination of the Construct Validity of the Cogniphobia Scale for Headache Disorders (CS-HD)

Abstract

Introduction: Cogniphobia is the fear and subsequent avoidance of cognitive exertion, which is believed to cause or exacerbate headache. The objective of the current study was to provide support for the construct validity of the Cogniphobia Scale for Headache Disorders (CS-HD) by using the CS-HD to demonstrate associations between cogniphobia and key fear-avoidance constructs. Methods: In this cross-sectional study, participants were 77 adults with migraine recruited from a tertiary headache center. Participants completed the CS-HD along with a series of self-report surveys and neuropsychological measures that assessed patient demographics, migraine diagnosis and headache characteristics, current pain severity, emotional state (anxiety, pain-related fear, and depression), cognitive exertion and subjective effort management, and functioning (disability, self-reported cognitive symptoms, and neuropsychological measures of premorbid intellect, attention, memory, and executive functioning). Results: The CS-HD associated with greater anxiety (PROMIS Anxiety; r = 0.34, p = 0.003), pain-related fear (PASS-20; p = 0.39,p = 0.001), self-reported cognitive symptoms (ABS; p = 0.39, p = 0.001), headache disability (HDI; r = 0.28, p = 0.017), and depression (PROMIS Depression; r = 0.25, p = 0.030). The CS-HD associated with lower scores on neuropsychological measures of semantic fluency (Animal Naming; r= -0.26, p = 0.027), visual immediate recall memory (RCFT Immediate Recall; r = -0.24,p = 0.036), visual delayed recall memory (RCFT Delayed Recall; r = -0.35, p = 0.002), and visual recognition memory (RCFT Recognition; r = -0.35, p = 0.003). Anxiety (PROMIS A) mediated the relationship between the CS-HD and headache disability (HDI; ab = 0.44, 95% CI = 0.17-0.87) and pain-related fear (PASS-20) mediated the relationship between the CS-HD and headache disability (HDI; ab = 0.63, 95% CI = 0.22-1.21). Anxiety (PROMIS A) also mediated the relationship between the CS-HD and self-reported cognitive symptoms (ABS; ab = 0.002, 95% CI = 0.0001-0.01). Discussion: This study provided support for the construct validity of the CS-HD by using the CS-HD to demonstrate associations between cogniphobia and key fear-avoidance constructs. Fear-avoidance constructs, such as cogniphobia, are likely important constructs to consider when evaluating migraine and headache-related functioning.