Learning headache triggers through experience: A laboratory study

Abstract

AbstractObjectiveTo examine how individuals may learn headache trigger beliefs through sequential symbolic pairings of trigger candidates and headache attacks.BackgroundLearning from experience may be a major source of information about headache triggers. Little is known about learning‐based influences on the establishment of trigger beliefs.MethodsThis cross‐sectional, observational study included N = 300 adults with headache who participated in a laboratory computer task. First, participants rated the chances (0%–100%) that encountering specific triggers would lead to experiencing a headache. Then, 30 sequential images with the presence or absence of a common headache trigger were presented alongside images representing the presence or absence of a headache attack. The primary outcome measure was the cumulative association strength rating (0 = no relationship to 10 = perfect relationship) between the trigger and headache using all previous trials.ResultsA total of N = 296 individuals completed 30 trials for each of three triggers, yielding 26,640 total trials for analysis. The median [25th, 75th] association strength ratings for each of the randomly presented headache triggers were 2.2 [0, 3] for the Color Green, 2.7 [0, 5] for Nuts, and 3.9 [0, 8] for Weather Changes. There was a strong association between the “true” cumulative association strength and corresponding ratings. A 1‐point increase on the phi scale (i.e., no relationship to perfect relationship) was associated with a 1.20 (95% CI: 0.81 to 1.49, p < 0.0001) point increase in association strength rating. A participant's prior belief about the potency of a trigger affected their perceived rating of the accumulating evidence, accounting for 17% of the total variation.ConclusionIn this laboratory task, individuals appeared to learn trigger–headache associations through repeated exposures to accumulating symbolic evidence. Prior beliefs about the triggers appeared to influence ratings of the strength of relationships between triggers and headache attacks.