title: Psychological flexibility in migraine: A study of pain acceptance and values-based action.
abstract: BACKGROUND
  Studies of musculoskeletal pain patients confirm that acceptance of pain and values-based action are strong predictors of pain-related disability and that interventions fostering "psychological flexibility" confer positive outcomes. However, data on these processes in migraine remain limited. This cross-sectional study examined relations between components of psychological flexibility and headache among treatment-seeking migraineurs.
  
  
  METHODS
  A total of 103 adults (M age = 41.5 (11.9) years; 88.2% female) with ICHD-confirmed migraine (71.8% episodic, 28.2% chronic) across three clinics completed measures of psychological flexibility and headache-related disability. Hierarchical regressions quantified relations between acceptance/values-based action and headache variables after first controlling for pain severity and gender.
  
  
  RESULTS
  Acceptance of pain and values-based action accounted for 10% of unique variance in headache severity (ΔR(2) p = 0.006) and up to 20% in headache-related disability (ΔR(2) ps = 0.02 and < 0.001) but were weakly related to headache frequency. Psychological flexibility was more strongly associated with MIDAS-measured disability than was headache severity or headache frequency. Significant effects were typically of medium-to-large size and driven primarily by values-based action.
  
  
  CONCLUSIONS
  Paralleling results from the broader chronic pain literature, pain acceptance and values-based action play significant roles in headache pain and disability. Further study of interventions targeting these processes may enhance existing treatments.
authors.affiliation: Department of Psychology, University of Mississippi, USA.
authors.forename: Heather Wolfort
authors.initials: HW
authors.lastname: Foote
authors.affiliation: Department of Psychology, University of Mississippi, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Hamer
authors.affiliation: Oxford Neurology Clinic, USA.
authors.forename: Malcolm M
authors.initials: MM
authors.lastname: Roland
authors.affiliation: Wesley Neurology and Headache Clinic, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Landy
authors.affiliation: Department of Psychology, University of Mississippi, USA tasmithe@olemiss.edu.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Smitherman
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D059350:Chronic Pain / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Migraine; acceptance; acceptance and commitment therapy; disability; headache; psychological flexibility