title: Cervico-cephalalgiaphobia: a subtype of phobia in patients with cervicogenic headache and neck pain? A pilot study.
abstract: OBJECTIVE
  The term 'cephalalgiaphobia' was introduced in the mid-1980s and defined as fear of migraine (attacks). We hypothesized that a specific subtype of cephalalgiaphobia affects patients with cervicogenic headache (CEH). This study aimed to: (1) define the term 'cervico-cephalalgiaphobia'; (2) develop a set of indicators for phobia relevant to patients with CEH; and (3) apply this set to a practice test in order to estimate the frequency of cervico-cephalalgiaphobia in the Dutch primary care practice of manual physical therapy.
  
  
  METHODS
  A systematic approach was used to develop a definition and potential indicators for cervico-cephalalgiaphobia. An expert group appraised the definition and the set of indicators (score per indicator: never; sometimes; often/always). An invitation to participate in the practice test was sent to Dutch manual physical therapy practices (n = 56) representing 134 manual physical therapists (MPTs). The cut-off point for percentages of scores for coverage of the indicators was set at ≥ 60%.
  
  
  RESULTS
  The expert group agreed with the proposed definition of cervico-cephalalgiaphobia. A set of eight indicators for cervico-cephalalgiaphobia was selected from 10 initial indicators. Thirty-six MPTs provided data from 46 patients diagnosed with CEH. The coverage of 'often/always' was substantial for the indicators, 'Short-term positive results in previous manual physical therapeutic treatment', 'Shorter interval between treatment sessions', 'Fear of "locked facet joints" of the neck', 'More frequent manipulation', and 'Fear of increase in headaches'. Coverage was also substantial for 'never' regarding 'Long-term positive results in previous manual physical therapeutic treatment'. 'Confirmation of "locked facet joints" of the cervical spine by MPT as a cause for increase of CEH' scored 'often/always' in all patients. Coverage for 'Increased use of medication with insufficient effect' was substantial, scoring as 'sometimes' in 39 (84.8%) patients.
  
  
  CONCLUSIONS
  Cervico-cephalalgiaphobia was defined and a set of eight indicators formulated based on the literature and clinical expertise. The practice test provides valuable information on the frequency of indicators for cervico-cephalalgiaphobia in the Dutch manual physical therapy practice, suggesting that cervico-cephalalgiaphobia is common in patients with CEH.
authors: Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Campus Jette, Belgium; Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, The Netherlands; Pain in Motion International Research Group (www.paininmotion.be), Vrije Universiteit Brussel, Campus Jette, Belgium.
authors: Rob A B
authors: RA
authors: Oostendorp
authors: Department of Public Health and Research, Radboud University Nijmegen Medical Centre, The Netherlands; Institute for Methodology and Statistics Beuningen, The Netherlands.
authors: Hans
authors: H
authors: Elvers
authors: Department of Physiotherapy, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland; Rehabilitation Clinic, Clinical Military Hospital No. 10 with Polyclinic, Bydgoszcz, Poland; Neurocognitive Laboratory, Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Torun, Poland.
authors: Emilia
authors: E
authors: Mikolajewska
authors: Pain in Motion International Research Group (www.paininmotion.be), Vrije Universiteit Brussel, Campus Jette, Belgium; Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
authors: Nathalie
authors: N
authors: Roussel
authors: SOMT Educational Institute for Musculoskeletal Therapy, Softwareweg 5, 3821 BN, Amersfoort, The Netherlands.
authors: Emiel
authors: E
authors: van Trijffel
authors: Department Medical Psychology, Radboud University Nijmegen Medical Centre, The Netherlands.
authors: Han
authors: H
authors: Samwel
authors: Pain in Motion International Research Group (www.paininmotion.be), Vrije Universiteit Brussel, Campus Jette, Belgium; Department of Physiotherapy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Campus Jette, Belgium; Department of Physiotherapy and Rehabilitation, University Hospital Brussels, Belgium.
authors: Jo
authors: J
authors: Nijs
authors: Department of Statistics, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium.
authors: William
authors: W
authors: Duquet
keywords: Cervicogenic headache; Chronic pain; Indicators; Manual physical therapy; Neck pain; Phobia