title: The Headache Triggers Sensitivity and Avoidance Questionnaire: Establishing the Psychometric Properties of the Questionnaire.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the psychometric properties of the newly developed Headache Triggers Sensitivity and Avoidance Questionnaire (HTSAQ) designed to measure variables relating to the Trigger Avoidance Model of Headaches.
  
  
  BACKGROUND
  The Trigger Avoidance Model of Headaches proposes that one pathway to developing a primary headache disorder is through the avoidance of headache triggers, resulting in an increase in trigger potency through sensitization. Conversely, prolonged exposure to certain triggers may reduce a potential trigger's ability to precipitate a headache. This model has led to an alternative approach to trigger management being proposed called Learning to Cope with Triggers, which advocates the desensitization of certain headache triggers through controlled exposure, while supporting avoidance of those triggers that are detrimental to health and wellbeing. To be able to evaluate predictions based on the Trigger Avoidance Model of Headaches and to investigate the effectiveness of Learning to Cope with Triggers, psychometrically sound measures of trigger sensitivity and trigger avoidance are needed.
  
  
  METHODS
  A convenience sample of 376 participants (87.5% female; 64.1% European descent) was recruited for the online study which consisted of a battery of measures including the HTSAQ, Brief Headache Screen, Pain Anxiety Symptoms Scale, Pain Sensitivity Questionnaire, Chronic Pain Acceptance Questionnaire, and demographic items. With an interval of 2-6 weeks, a subsample of participants (n = 201) completed the HTSAQ for a second time. The mean age of the sample was 31.4 years (SD = 12.8). The most common headache diagnoses (based on the Brief Headache Screen) were migraine (chronic = 62; episodic = 160), followed by medication-overuse headache (n = 87). The remaining participants (n = 67) were diagnosed as having episodic less severe headache (most likely tension-type headache).
  
  
  RESULTS
  Reliability was assessed through internal consistency and test-retest reliability over a period of 2-6 weeks, and both were excellent (alpha > .80). Strong construct validity was demonstrated by the measure's scale scores being significantly correlated in theoretically consistent ways with the Pain Sensitivity Questionnaire, Pain Anxiety Symptoms Scale, and Chronic Pain Acceptance Questionnaire. As the Trigger Avoidance Model of Headaches would predict, correlations between the HTSAQ Sensitivity scales and the Avoidance scale were strong (P < .001), and participants with chronic migraine had significantly higher HTSAQ scores than those with episodic headaches.
  
  
  CONCLUSIONS
  The findings support the use of the HTSAQ as a valid and reliable tool for assessing sensitivity to headache triggers and avoidance of headache triggers. Further research examining the factor structure of the HTSAQ is warranted.
authors.affiliation: School of Applied Psychology, Griffith University, Brisbane, Australia.
authors.forename: Sonja U
authors.identifier: http://orcid.org/0000-0001-5787-724X
authors.initials: SU
authors.lastname: Kubik
authors.affiliation: School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Martin
mesh_terms: D000328:Adult; D001007:Anxiety; D001362:Avoidance Learning; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D020773:Headache Disorders / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D020407:Internet; D008297:Male; D008959:Models, Neurological; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: assessment; avoidance; migraine; sensitivity; tension-type headache; triggers