Acceptance, Psychiatric Symptoms, and Migraine Disability: An Observational Study in a Headache Center

Elizabeth K Seng; Alexander J Kuka; Sarah Jo Mayson; Todd A Smitherman; Dawn C Buse

doi:10.1111/head.13325

Acceptance, Psychiatric Symptoms, and Migraine Disability: An Observational Study in a Headache Center

Headache. 2018 Jun;58(6):859-872. doi: 10.1111/head.13325.

Authors

Elizabeth K Seng^{1

2}, Alexander J Kuka³, Sarah Jo Mayson⁴, Todd A Smitherman³, Dawn C Buse²

Affiliations

¹ Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA.
² Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
³ Department of Psychology, University of Mississippi, Oxford, MS, USA.
⁴ Penn Medicine, Philadelphia, PA, USA .

Abstract

Objective: To evaluate relationships between psychiatric symptoms, acceptance, and migraine-related disability in a sample of people with migraine presenting at a tertiary care headache center.

Background: Migraine is a chronic disease that can be severely disabling. Despite a strong theoretical basis and evidence in other pain conditions, little is known about relationships between acceptance, psychiatric symptoms, and migraine-related disability.

Methods: Ninety patients with physician-diagnosed migraine completed surveys assessing demographics, headache symptoms, severe migraine-related disability (Migraine Disability Assessment Scale total score dichotomized at ≥ 21), depression (Patient Health Questionnaire-9) and anxiety symptoms (Generalized Anxiety Disorder-7), and acceptance (Chronic Pain Acceptance Questionnaire; subscales: Pain Willingness and Activity Engagement).

Results: Participants (77.8% white, non-Hispanic; 85.6% women; and 50.0% with a graduate level education) reported an average headache pain intensity of 6.7/10 (SD = 2.0). One-third (36.0%) reported chronic migraine, and half (51.5%) reported severe migraine-related disability. Lower acceptance was associated with severe migraine-related disability, t(54) = 4.13, P < .001. Higher activity engagement was associated with lower average headache pain intensity (r = -.30, P = .011). Higher acceptance was associated with lower levels of depression (r = -.48, P < .001) and anxiety symptoms (r = -.37, P = .003). Pain willingness and activity engagement serially mediated relationships between depression symptoms and severe migraine-related disability (indirect effect = 0.05, 95% CI = 0.01, 0.15), and between anxiety symptoms and severe migraine-related disability (indirect effect = 0.12, 95% CI = 0.02, 0.31).

Conclusion: Results provided preliminary support for a theoretical pathway by which psychiatric symptoms may influence migraine-related disability, in part, through their relationships with pain willingness and activity engagement.

Keywords: acceptance; anxiety; depression; disability; migraine.

Publication types

Observational Study

MeSH terms

Behavior*
Female
Humans
Male
Mental Disorders / complications
Mental Disorders / psychology*
Migraine Disorders / complications
Migraine Disorders / psychology*
Models, Psychological
Pain Perception
Persons with Disabilities / psychology*
Preliminary Data
Surveys and Questionnaires

Grants and funding

K23 NS096107/NS/NINDS NIH HHS/United States