Avoidance behaviour modulates but does not condition phonophobia in migraine.

BACKGROUND: Past studies do not account for avoidance behaviour in migraine as a potential confounder of phonophobia. OBJECTIVE: To analyse whether phonophobia is partially driven by avoidance behaviour when using the classic methodology (method of limits). METHODS: This is a case-control study where we tested phonophobia in a cohort of high-frequency/chronic migraine patients (15.5 ± 0.74 headache days/month) and non-headache controls. Auditory stimuli, delivered in both ears, were presented using three different paradigms: the method of limits, the method of constant stimuli, and the adaptive method. Participants were asked to report how bothersome each tone was until a sound aversion threshold was estimated for each method. RESULTS: In this study, we successfully replicate previously reported reduction in sound aversion threshold using three different methods in a group of 35 patients and 25 controls (p < 0.0001). Avoidance behaviour in migraine reduced sound aversion threshold in the method of limits (p = 0.0002) and the adaptive method (p < 0.0001) when compared to the method of constant stimuli. While thresholds in controls remained the same across methods (method of limits, p = 0.9877 and adaptive method, p = 1). CONCLUSION: Avoidance behaviour can exacerbate phonophobia. The current methodology to measure phonophobia needs to be revised.

What sound sources trigger misophonia? Not just chewing and breathing.

OBJECTIVES: Misophonia is a highly prevalent yet understudied condition characterized by aversion toward particular environmental sounds. Oral/nasal sounds (e.g., chewing, breathing) have been the focus of research, but variable experiences warrant an objective investigation. Experiment 1 asked whether human-produced oral/nasal sounds were more aversive than human-produced nonoral/nasal sounds and non-human/nature sounds. Experiment 2 additionally asked whether machine-learning algorithms could predict the presence and severity of misophonia. METHOD: Sounds were presented to individuals with misophonia (Exp.1: N = 48, Exp.2: N = 45) and members of the general population (Exp.1: N = 39, Exp.2: N = 61). Aversiveness ratings to each sound were self-reported. RESULTS: Sounds from all three source categories-not just oral/nasal sounds-were rated as significantly more aversive to individuals with misophonia than controls. Further, modeling all sources classified misophonia with 89% accuracy and significantly predicted misophonia severity (r = 0.75). CONCLUSIONS: Misophonia should be conceptualized as more than an aversion to oral/nasal sounds, which has implications for future diagnostics and experimental consistency moving forward.