Cogniphobia in Mild Traumatic Brain Injury

Cogniphobia refers to avoidance of mental exertion out of a fear of developing or exacerbating a headache. Headaches are very common after mild traumatic brain injury (mTBI) and often become chronic. Cogniphobia is hypothesized to contribute to poor cognitive test performance and persistent disability in some patients with mTBI. Eighty patients with mTBI and post-traumatic headaches were recruited from specialty outpatient clinics. They completed a battery of questionnaires (including a cogniphobia scale) and neuropsychological tests (the National Institutes of Health Toolbox Cognition Battery and the Medical Symptom Validity Test) at 2-3 months post injury, in a cross-sectional design. Participants with more severe headaches reported higher levels of cogniphobia. Cogniphobia was associated with lower performance on memory testing (but not other cognitive tests), independent of headache severity. Participants who avoided mental exertion also tended to avoid physical activity and traumatic stress triggers. The findings provide preliminary support for the role of cogniphobia in persistent cognitive difficulties after mTBI, and suggest that cogniphobia may reflect a broader avoidant coping style.