Anxiety Sensitivity as a Risk Indicator for Anxiety, Depression, and Headache Severity in Women With Migraine

Abstract

Objective The primary aim of this exploratory study was to assess the relationship between anxiety sensitivity and emotional disorders, migraine characteristics, and migraine‐related fear and avoidance behaviors in women with probable migraine. Background Anxiety and depressive disorders are the most frequent comorbid psychiatric conditions in migraine, particularly in women; however, the underlying reasons for these comorbidities are uncertain. Anxiety sensitivity, the tendency to catastrophically appraise anxiety and bodily sensations in terms of their physical, social, or cognitive consequences, is a psychological factor that may contribute to the comorbidity of anxiety and depressive disorders and migraine. It was hypothesized that anxiety sensitivity would be associated with greater migraine severity and psychiatric symptoms. Method Participants were women (n = 100) who screened positive for migraine on the validated IDMigraine Screener participated in an anonymous single‐session online survey‐based study on migraine. The Anxiety Sensitivity Index‐3 total and subscales scores were used to assess anxiety sensitivity. Anxiety and depression symptoms were assessed with the brief Patient Health Questionnaire. Results On average, anxiety sensitivity was clinically elevated (mean ± SD: 24.0 ± 15.2). Anxiety sensitivity cognitive and social concerns were most strongly correlated with severity of anxiety (r's = .38‐.46) and depressive symptoms (r = .35‐.39, P's < .001), and all anxiety sensitivity facets were related to fear of head pain (r's = .35‐.38, P's < .001). Anxiety sensitivity cognitive concern facet was uniquely related to headache patterns, including longer migraine attack duration (r = .22, P = .029) and pain intensity (r = .24, P = .029), pain‐related avoidance, including avoiding movement and more frequent misuse of prescribed or non‐prescribed pain medication (r's = .20‐.21, P's < .01). Conclusions These novel findings indicate that anxiety sensitivity, specifically fearful appraisal of bodily sensations, are linked to both psychiatric symptoms and migraine severity in women. In this cross‐sectional study, causal sequence cannot be determined. If anxiety sensitivity leads to more severe pain and psychiatric distress, targeting anxiety sensitivity could lead to better headache outcomes.

The impact of Pain-related emotions on migraine

“…The present study showed that migraine sufferers have a range of moderate to severe pain-related anxiety, according to the PASS score (47.4 ± 17.2). It is known that anxiety is significantly associated with an increased risk of migraine 30,38 . The PCS is a tool for evaluating catastrophizing chronic pain disorders.…”

Management of chronic migraine

“…Because migraine has a strong association with depression and anxiety, clinicians and patients often gravitate toward the incorrect conclusion that one disease “causes” the other 39. These conditions should be considered comorbidities and treated as such, as treating one condition can often favorably affect the other 4041. Patients should be screened for stress and mood disorders and referred appropriately for treatments as needed.…”

Association of Sleep Reactivity and Anxiety Sensitivity with Insomnia-Related Depression and Anxiety among City Government Employees in Japan

“…Although there are no studies showing that sleep reactivity and anxiety sensitivity are associated with specific physical diseases, anxiety sensitivity has been found to be associated with pain severity in headaches [ 29 ].…”