Avoidance behaviour modulates but does not condition phonophobia in migraine

Background Past studies do not account for avoidance behaviour in migraine as a potential confounder of phonophobia. Objective To analyse whether phonophobia is partially driven by avoidance behaviour when using the classic methodology (method of limits). Methods This is a case-control study where we tested phonophobia in a cohort of high-frequency/chronic migraine patients (15.5 +/- 0.74 headache days/month) and non-headache controls. Auditory stimuli, delivered in both ears, were presented using three different paradigms: the method of limits, the method of constant stimuli, and the adaptive method. Participants were asked to report how bothersome each tone was until a sound aversion threshold was estimated for each method. Results In this study, we successfully replicate previously reported reduction in sound aversion threshold using three different methods in a group of 35 patients and 25 controls (p < 0.0001). Avoidance behaviour in migraine reduced sound aversion threshold in the method of limits (p = 0.0002) and the adaptive method (p < 0.0001) when compared to the method of constant stimuli. While thresholds in controls remained the same across methods (method of limits, p = 0.9877 and adaptive method, p = 1). Conclusion Avoidance behaviour can exacerbate phonophobia. The current methodology to measure phonophobia needs to be revised.

Automated summary

The study found that avoidance behavior may exacerbate phonophobia, and the current methods for measuring phonophobia need to be revised.