Cognitive correlates of headache intensity and duration.
Cognitive processes and cognitive styles of persistent headache sufferers were examined in relation to indices of intensity and duration of head pain. One hundred and eight persistent headache patients, referred for cognitive-behavioral management of their disorder, completed questionnaires designed to assess: distressing thoughts and feelings experienced during headache attacks, evaluation of the experienced pain, perceived influence of stress and worry on headaches, and capacity to verbally express emotions. The results showed that the intensity of head pain correlated with measures of headache-related distress and with the proportion of headache-related distress to situation-related distress. Duration of head pain was also associated with the proportion of headache-related distress to situation-related distress, and additionally with a tendency to deny the influence of stress and worry on headaches and with difficulty in expressing emotions. These findings were taken as support of our previously stated hypothesis that head pain of increased severity is associated with a cognitive shift whereby the patient's primary concern moves from situational and interpersonal distress to distress associated with the disorder itself. In addition, these findings point to affective distress and lack of emotional expressiveness as correlating differentially with the headache dimensions of intensity and duration.