Headache as a Stressor: Dysfunctional versus Adaptive Coping Styles

The common stressor faced by all headache sufferers is the headache itself. Dysfunctional headache coping styles can be classified as sensitizing (hypervigilance and anticipation, catastrophizing, hyperempathy) or minimizing (alexithymia, stoic denial, anger suppression). Dysfunctional coping often takes place in an interpersonal context (theater of pain), marked by excessive pain behavior and embellishment, catastrophizing and hypervigilance in the family, stoicism and misinterpretation of pain, pain language as a substitute for emotional expression, or enabling of disability and pseudo-coping. More adaptive coping styles include balanced use of distraction and body awareness, strategic proactive coping, balanced interpersonal discussion of pain, and pain acceptance. In addition to headache-related research on coping styles, this article reviews relevant studies from neuroimaging, non-headache chronic pain disorders, and clinical experience in a comprehensive, multidisciplinary headache center.