title: Depressive symptoms and insecure attachment as predictors of disability in a clinical population of patients with episodic and chronic migraine.
abstract: OBJECTIVE
  To define predictors of migraine-related disability in patients with episodic and chronic migraine referred to a specialty migraine clinic, focusing on depressive symptoms and insecure attachment style that, because of their association with responses to pain and physical illness, might be predictive of greater migraine-related disability.
  
  
  BACKGROUND
  The Migraine Disability Assessment questionnaire (MIDAS) has proved to be a reliable and easy-to-use instrument to assess migraine-related disability. As clinicians are increasingly using MIDAS in their diagnostic and treatment decisions for patient care, an understanding of the factors influencing migraine-related disability is essential for a rationale use of such an instrument.
  
  
  METHODS
  Two-hundred patients suffering from episodic migraine without aura (EM), and chronic migraine (CM) with and without medication overuse, and referred to a specialty headache clinic were evaluated using the MIDAS, the Beck Depression Inventory (BDI), and the Attachment Style Questionnaire (ASQ). Diagnosis of episodic and chronic migraine was operationally defined according to the International Headache Society (IHS) and Silberstein-Lipton criteria.
  
  
  RESULTS
  Multiple regression analysis showed that, in the total sample, disability was higher in those patients with CM, more severe depressive symptoms, an insecure style of attachment (as reflected by a lower score on the ASQ confidence scale), and experiencing more severe headache pain intensity. In the subgroup of patients with episodic migraine, an insecure style of attachment emerged as the most significant predictor of disability (other significant predictors were female sex and number of headache days per month). In contrast, in the subgroup of patients with CM, the only significant predictor of the total MIDAS score was a greater severity of depressive symptoms.
  
  
  CONCLUSIONS
  Our findings demonstrate the relevance of attachment style, an enduring psychological trait not evaluated in previous studies, in influencing the disability level in patients with migraine and confirm the role of comorbid depressive symptoms in modulating the impact of migraine on every day functioning.
authors.affiliation: Headache Clinic, INI Grottaferrata, and Department of Neuroscience, University of Rome Tor Vergata, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Rossi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Di Lorenzo
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Malpezzi
authors.forename: Cherubino
authors.initials: C
authors.lastname: Di Lorenzo
authors.forename: Francesco
authors.initials: F
authors.lastname: Cesarino
authors.forename: Jessica
authors.initials: J
authors.lastname: Faroni
authors.forename: Alberto
authors.initials: A
authors.lastname: Siracusano
authors.forename: Alfonso
authors.initials: A
authors.lastname: Troisi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003863:Depression; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000523:psychology*; D020326:Migraine without Aura / Q000523:psychology*; D010287:Parent-Child Relations; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards