Psychological factors associated with headache frequency, intensity, and headache-related disability in migraine patients

Abstract

Background Several psychological cofactors of migraine have been identified, but relationships to different headache parameters (e.g., headache frequency vs. headache-related disability) are only incompletely understood. Methods We cross-sectionally assessed 279 migraine patients at their first presentation at our tertiary headache center. We obtained headache and acute medication frequency, pain intensity, the Migraine Disability Assessment Scale (MIDAS), and the Pain Disability Index (PDI) as headache-related outcomes as well as scores of the Hospital Anxiety and Depression Scale (HADS), the Pain Catastrophizing Scale (PCS), Pain-Related Control Scale (PRCS), and Avoidance Endurance Questionnaire (AEQ) as psychological factors. Results Linear regression models revealed the highest associations of the psychological factors with the PDI (adjusted R2 = 0.296, p < 0.001, independent predictors: PCS, AEQ social avoidance, depression) followed by the MIDAS (adjusted R2 = 0.137, p < 0.001, predictors: depression, AEQ social avoidance) and headache frequency (adjusted R2 = 0.083, p < 0.001, predictors: depression, AEQ humor/distraction). Principal component analysis corroborated that psychological factors were preferentially associated with the PDI, while the MIDAS loaded together with headache frequency. Conclusion Our results suggest that psychological factors are more strongly associated with the subjective degree of headache-related disability measured by the PDI than with the days with disability (MIDAS) or the more objective parameter of headache frequency. This once again highlights the need for comprehensive assessment of migraine patients with different headache parameters and the need for considering psychological treatment, especially in patients with high disability.

Applying a biopsychosocial model to migraine: rationale and clinical implications

“…Individuals with migraine may also struggle in accepting and coping with pain, leading to high levels of self-perceived headache-related disability [ 159 ] and pain catastrophizing [ 160 ]. The variable frequency of symptoms and the largely unpredictable timing of severe migraine attacks can result in individuals feeling that they have no control over their illness [ 18 ].…”

A Single-Group Study on the Effect of OnabotulinumtoxinA in Patients with Chronic Migraine Associated with Medication Overuse Headache: Pain Catastrophizing Plays a Role

“…Several factors have been shown to promote migraine “chronification”, or persistent increase, such as metabolic factors, comorbidities, genetic predisposition, lifestyle, medication overuse, and psychological factors [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Among the latter, pain catastrophizing has been postulated as a potential mechanism of action in the progression of migraine frequency [ 27 , 28 , 29 , 30 ].…”

“…Several factors have been shown to promote migraine “chronification”, or persistent increase, such as metabolic factors, comorbidities, genetic predisposition, lifestyle, medication overuse, and psychological factors [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Among the latter, pain catastrophizing has been postulated as a potential mechanism of action in the progression of migraine frequency [ 27 , 28 , 29 , 30 ]. Pain catastrophizing is a common psychological trait among individuals with migraine, detected in around one fourth of the patients [ 31 ], and it is defined as a negative anxiety-driven set of emotions in response to anticipated or actual pain.…”

Headache in Workers: A Matched Case–Control Study

“…As we saw in our sample, psychosocial factors play a leading role in headache disorders. Psychological factors play a significant role in frequency, intensity, and headache-related disability [ 91 ]. Genetic factors govern the relationship between social stressors and headache [ 92 ].…”