Learning headache triggers through experience: A laboratory study

Objective To examine how individuals may learn headache trigger beliefs through sequential symbolic pairings of trigger candidates and headache attacks. Background Learning 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. Methods This 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. Results A 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