Time-course of attentional bias for threat-related cues in patients with chronic daily headache–tension type: evidence for the role of anger

This study investigated the role of anger in attentional bias for linguistic threat-related stimuli in individuals with chronic daily headache (CDH) tension type and healthy controls. Attentional bias was assessed using a visual probe task which presented pain-related (sensory and affective), social threat, anger-related, and neutral words at two exposure duration conditions: 500 ms and 1250 ms. Compared to healthy controls, individuals with CDH showed significantly greater attentional bias towards pain-related words at 1250 ms, indicating a bias in maintained attention to pain cues in this group. No significant differences between groups were found in attentional bias scores at the shorter stimulus duration of 500 ms. No significant differences between groups were found in attentional bias scores to social threat and anger-related words at either stimulus presentation duration. When compared to 0, in all group and duration combinations there was significant positive bias towards anger. Across the whole sample, pain bias scores at 1250 ms were significantly associated with anger out, whilst anger bias scores at both 500 ms and 1250 ms correlated significantly with trait anger. The results of the present investigation support the content-specificity hypothesis, according to which attentional bias in patients with chronic pain is shown only towards pain-related cues. Moreover, the current pattern of results highlights the importance of exploring further the role of anger in the aetiology and maintenance of chronic pain in general, and CDH tension type in particular.