The relationship between migraine and some psychological features has been reported for more than a century. A strong bidirectional association between migraine and depression or anxiety has been demonstrated by several studies while the connection with eating, bipolar and other disorders still remains possible [
1‐
6]. An increased risk of suicide attempt has been demonstrated in migraineurs, especially in those suffering from migraine with aura [
1‐
7]. Moreover, patients suffering from migraine and chronic daily headache reported severe hopelessness and perceived disability [
6]. This comorbidity increases therefore the severity of perception of headache symptoms and impact the quality of life, posing additional challenges for an effective patient management. Psychiatric disorders can also modify the migraine course raising the risk of transformation in a chronic form [
1,
2,
6]. The link between migraine and lifetime anxiety disorders (panic, obsessive-compulsive disorders, generalized anxiety, phobias) was described in both clinical and population-based studies [
1‐
6,
8‐
12]. It has been demonstrated that the prevalence of anxiety-spectrum disorders in migraineurs ranges from 9.1% to 24.6%, compared to 2.5-12.0% in general population [
8,
13,
14]. A phobia is a persistent, excessive, and unreasonable fear of a specific object or situation that induces to avoid it, despite the awareness and reassurance that it is not dangerous. It can significantly interfere with social and occupational functioning [
15]. A few studies focused on the relationship between migraine and phobic disorders: Ratcliffe and colleagues [
14] investigated the prevalence of mental disorders in migraineurs compared to healthy controls showing an increased rate of social phobia [3.0% vs. 1.9%, odds ratio (OR) = 1.38], agoraphobia (6.3% vs. 1.5%, OR = 3.21) and simple phobia (15.1% vs. 6.8%, OR = 1.97). Conversely, Senaratne et al. [
16] found a migraine prevalence of 22.0% in patients suffering from phobia. Merikangas et al. [
17], in a prospective study, registered an increased risk of phobia, especially of simple and social phobia, in migraineurs with aura. In a prospective study of the Epidemiologic Catchment Area Study of Baltimore [
18], Swartz et al. highlighted how phobia was predictive of incident migraine [OR = 1.70, 95% confidence interval (CI): 1.11-2.58]. Moreover, authors reported also a significant association between prevalent migraine and phobia (OR = 1.43, 95% CI: 1.07-1.91), in particular agoraphobia (OR = 1.88, 95% CI: 1.33-2.67) and simple phobia (OR = 1.35, 95% CI: 1.02-1.79) [
18]. Although psychiatric disorders are not a comorbidity of migraine only, they may play an important role in its chronicization as well as in medication overuse [
1,
5,
19‐
27]. Corchs et al. [
28] investigated the psychiatric profile of patients suffering from chronic migraine showing that 60.7% of them presented a phobic anxious condition in their lifespan, 35.7% had a diagnosis of specific phobia, 26.8% had social phobia and two agoraphobia. Comparing migraineurs and patients suffering from Medication Overuse Headache deriving from migraine, Radat et al. [
24] registered an increased risk of social phobia (34.1% vs. 12.2%; OR = 4.3, 95% CI: 1.3 – 14.5) in the second group. A specific kind of phobia directed against illness has been also described and distinguished from hypochondria [
29]. In this condition, patients who have experienced a health problem develop the fear that it might reappear again: that is what happens for example in patients with heart diseases or other chronic conditions and also in migraineurs, scared to have a major attack of migraine. This last trouble, called cephalalgiaphobia, has been described by Peres et al. [
29] as a new possible specific illness phobia. In their study, they investigated a sample of 12 patients followed at a tertiary headache clinic in Brazil showing anticipatory anxiety, fear of a headache attack during a pain-free period or worsening of the pain during a period of mild headache. As avoidance behavior, patients overused acute medications despite being aware that it was the fear of having another migraine attack or a headache exacerbation that made them take more analgesics than necessary. Authors hypothesized also that cephalalgiaphobia may decrease the threshold for initiating the analgesic consumption behavior leading to acute medication overuse [
29]. No other study on this topic has been published to date. Our study aims at evaluating whether cephalalgiaphobia was related to migraine frequency, aura status, medication overuse and, finally, if it was per se a predictor of increase in migraine frequency.