Psychological Factors May Be Treatment Target in Chronic Migraine

Cognitive Behavioral Therapy
Cognitive Behavioral Therapy
The study found a strong link between chronic migraine and psychological symptoms and beliefs that contribute to disability.

Psychological factors such as catastrophizing of pain are common in migraine and, along with depression and anxiety, contribute significantly to migraine-related disability, according to an observational study published in Headache aimed at better defining features of distress in chronic migraine.

“The goal is to identify factors that could serve as treatment targets to improve migraine frequency, and reduce migraine-related disability,” explained lead investigator Elizabeth K. Seng, PhD, assistant professor, Ferkauf Graduate School of Psychology, Yeshiva University and research assistant professor, department of neurology, Albert Einstein College of Medicine in New York.

Dr Seng and colleagues recruited 110 current patients with headache from Montefiore Headache Center during a 3-month period in 2014 for a self-reported study. Of the 90 qualified patients with migraine who returned the survey, 57 (64%) had episodic migraine (<15 days per month) and 32 had chronic migraine (≥15 days per month). The majority of participants (85%) were women and the median age was 45, with first headaches reported at mean age 21.4±10.4.

Three-quarters of the patients (68/89) reported some degree of disability. Using the Migraine Disability Assessment (MIDAS) questionnaire, slightly more than half of those patients (51.5%) reported severe disability (MIDAS score ≥21), while 48.5% reported low to moderate levels (MIDAS score <21). “We found that even moderate levels of symptomology were associated with significant migraine-related disability,” said co-investigator Dawn C. Buse, PhD, associate professor in the department of neurology at Albert Einstein College of Medicine of Yeshiva University. 

The severity of disability corresponded to headache frequency. Symptoms of depression (odds ratio [OR] 53.54; 95% CI, 51.49-8.41), anxiety (OR 53.65; 95% CI, 51.65-8.06), and pain catastrophizing (OR 51.95; 95% CI, 51.14-3.35), were higher in people reporting severe migraine disability. Higher depressive symptoms were more likely to be associated with both chronic migraine (vs episodic migraine) and severe migraine-related disability (vs mild to moderate migraine-related disability), Dr Seng pointed out.

In addition to depression, chronic migraine was associated with significantly higher levels of pain catastrophizing (OR 51.95; 95% CI,51.14-3.35) and higher migraine-specific chance locus of control (HSLC), the belief that migraine onset and course are random and beyond the patient’s control (OR 51.85; 95% CI, 51.13-1.43). “One of the most interesting things we found was that people with chronic migraine (who have 15 or more headache days per month) endorsed higher beliefs that headache episodes are controlled by chance or fate, compared to people with episodic migraine,” Dr Seng told Neurology Advisor.

Whether HSLC beliefs or the tendency to catastrophize pain are personality traits that influence migraine disability, or merely formed and enhanced by the chronicity of pain, was not explored. “It seems to be bi-directional that higher migraine frequency is associated with greater psychological distress and there are certain psychological traits and features that predispose someone to greater migraine-related disability,” Dr Buse noted.

The study outcomes pointed to a strong link between chronic migraine and psychological symptoms and beliefs that contribute to disability. The investigators concluded that treatment of psychological comorbidities would likely improve the clinical course of migraine, and that catastrophizing is a target of therapy for chronic migraine.

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Seng EK, Buse DC, Klepper JE, et al. Psychological factors associated with chronic migraine and severe migraine-related disability: An observational study in a tertiary headache center [published online January 31, 2017]. Headache. doi:10.1111/head.13021