title: Clinical Pain Catastrophizing in Women With Migraine and Obesity.
abstract: OBJECTIVE
  Obesity is related to migraine. Maladaptive pain coping strategies (eg, pain catastrophizing) may provide insight into this relationship. In women with migraine and obesity, we cross-sectionally assessed: (1) prevalence of clinical catastrophizing; (2) characteristics of those with and without clinical catastrophizing; and (3) associations of catastrophizing with headache features.
  
  
  METHODS
  Obese women migraineurs seeking weight loss treatment (n = 105) recorded daily migraine activity for 1 month via smartphone and completed the Pain Catastrophizing Scale (PCS). Clinical catastrophizing was defined as total PCS score ≥30. The six-item Headache Impact Test (HIT-6), 12-item Allodynia Symptom Checklist (ASC-12), Headache Management Self-Efficacy Scale (HMSE), and assessments for depression (Centers for Epidemiologic Studies Depression Scale) and anxiety (seven-item Generalized Anxiety Disorder Scale) were also administered. Using PCS scores and body mass index (BMI) as predictors in linear regression, we modeled a series of headache features (ie, headache days, HIT-6, etc) as outcomes.
  
  
  RESULTS
  One quarter (25.7%; 95% confidence interval [CI] = 17.2-34.1%) of participants met criteria for clinical catastrophizing: they had higher BMI (37.9 ± 7.5 vs 34.4 ± 5.7 kg/m(2) , P = .035); longer migraine attack duration (160.8 ± 145.0 vs 97.5 ± 75.2 hours/month, P = .038); higher HIT-6 scores (68.7 ± 4.6 vs 64.5 ± 3.9, P < .001); more allodynia (7.0 ± 4.1 vs 4.5 ± 3.5, P < .003), depression (25.4 ± 12.4 vs 13.3 ± 9.2, P < .001), and anxiety (11.0 ± 5.2 vs 5.6 ± 4.1, P < .001); and lower self-efficacy (80.1 ± 25.6 vs 104.7 ± 18.9, P < .001) compared with participants without clinical catastrophizing. The odds of chronic migraine were nearly fourfold greater in those with (n = 8/29.6%) vs without (n = 8/10.3%) clinical catastrophizing (odds ratio = 3.68; 95%CI = 1.22-11.10, P = .021). In all participants, higher PCS scores were related to more migraine days (β = 0.331, P = .001), longer attack duration (β = 0.390, P < .001), higher HIT-6 scores (β = 0.425, P < .001), and lower HMSE scores (β = -0.437, P < .001). Higher BMI, but not higher PCS scores, was related to more frequent attacks (β = -0.203, P = .044).
  
  
  CONCLUSIONS
  One quarter of participants with migraine and obesity reported clinical catastrophizing. These individuals had more frequent attacks/chronicity, longer attack duration, higher pain sensitivity, greater headache impact, and lower headache management self-efficacy. In all participants, PCS scores were related to several migraine characteristics, above and beyond the effects of obesity. Prospective studies are needed to determine sequence and mechanisms of relationships between catastrophizing, obesity, and migraine.
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA.
authors.forename: Dale S
authors.initials: DS
authors.lastname: Bond
authors.affiliation: Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Dawn C
authors.initials: DC
authors.lastname: Buse
authors.affiliation: Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA.
authors.forename: J Graham
authors.initials: JG
authors.lastname: Thomas
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA.
authors.forename: Lucille
authors.initials: L
authors.lastname: Rathier
authors.affiliation: Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Roth
authors.affiliation: Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Jelena M
authors.initials: JM
authors.lastname: Pavlovic
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA.
authors.forename: E Whitney
authors.initials: EW
authors.lastname: Evans
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA.
authors.forename: Rena R
authors.initials: RR
authors.lastname: Wing
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D015992:Body Mass Index; D058443:Catastrophization / Q000453:epidemiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000453:epidemiology; D016014:Linear Models; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology* / Q000523:psychology; D009765:Obesity / Q000453:epidemiology* / Q000523:psychology; D010147:Pain Measurement; D015995:Prevalence; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: allodynia; migraine; obesity; pain catastrophizing; smartphone; woman