Fear of death increases nocebo-prone behavior in people with headaches during covid-19. A longitudinal observational survey

BACKGROUND: The nocebo effect greatly affects pain management. We investigated the nocebo-prone behavior in people with headaches during and after the COVID-19 pandemic, for which there is clear evidence that the nocebo effect increased. METHODS: Individuals with headaches completed a series of questionnaires, including the Q-No, MIDAS, HIT-6, fear of death because of COVID-19 (a questionnaire including levels from 0 = no fear, to 3 = intense fear of death), and Hamilton Anxiety and Depression Rating Scale, over three consecutive periods. Period A was characterized by prolonged lockdowns, period B by strict pandemic regulations, and period C by the lifting of containment measures. Fear of death due to COVID-19 was recorded by 27.8%, 23.2% and 15.2%. Nocebo-prone behavior was independently associated with fear of death, anxiety symptoms, monthly headache days and HIT-6 score. . CONCLUSION: Nocebo-prone behavior in individuals with headache appears to be dynamic and associated with psychological and clinical burden. Targeted, personalized interventions addressing fear, anxiety, and headache burden may mitigate nocebo effects and optimize headache management.