title: Psychological Factors Associated With Chronic Migraine and Severe Migraine-Related Disability: An Observational Study in a Tertiary Headache Center.
abstract: OBJECTIVE
  To evaluate the relationships among modifiable psychological factors and chronic migraine and severe migraine-related disability in a clinic-based sample of persons with migraine.
  
  
  BACKGROUND
  Evidence evaluating relationships between modifiable psychological factors and chronic migraine and severe migraine-related disability is lacking in people with migraine presenting for routine clinical care.
  
  
  METHODS
  Adults with migraine completed surveys during routinely scheduled visits to a tertiary headache center. Participants completed surveys assessing chronic migraine (meeting criteria for migraine with ≥15 headache days in the past month), severe migraine disability (Migraine Disability Assessment Scale score ≥ 21), and modifiable psychological factors (depressive symptoms [Patient Health Questionnaire-9], anxious symptoms [Generalized Anxiety Disorder-7], Pain Catastrophizing Scale and Headache Specific Locus of Control). Logistic regression evaluated relationships between modifiable psychological factors and chronic migraine and severe migraine disability.
  
  
  RESULTS
  Among 90 eligible participants the mean age was 45.0 (SD = 12.4); 84.8% were women. One-third (36.0%) met study criteria for chronic migraine; half of participants (51.5%) reported severe migraine-related disability. Higher depressive symptoms (OR = 1.99, 95% CI = 1.11, 3.55) and chance HSLC (OR = 1.85, 95% CI = 1.13, 1.43) were associated with chronic migraine. Higher depressive symptoms (OR = 3.54, 95%CI = 1.49, 8.41), anxiety symptoms (OR = 3.65, 95% CI = 1.65, 8.06), and pain catastrophizing (OR = 1.95, 95% CI = 1.14, 3.35), were associated with severe migraine-related disability.
  
  
  CONCLUSIONS
  Psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance locus of control were associated with chronic migraine. This study supports the need for longitudinal observational studies to evaluate the relationships among naturalistic variation in psychological factors, migraine-related disability, and migraine chronification.
authors.affiliation: Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.|Albert Einstein College of Medicine, Bronx, NY, USA.|Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Seng
authors.affiliation: Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.|Albert Einstein College of Medicine, Bronx, NY, USA.|Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Dawn C
authors.initials: DC
authors.lastname: Buse
authors.affiliation: Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
authors.forename: Jaclyn E
authors.initials: JE
authors.lastname: Klepper
authors.affiliation: Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: J Mayson
authors.affiliation: Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Grinberg
authors.affiliation: Hartford Healthcare Headache Center, Wethersfield, CT, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Grosberg
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, USA.|Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Jelena M
authors.initials: JM
authors.lastname: Pavlovic
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, USA.|Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Robbins
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, USA.|Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Vollbracht
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, USA.|Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
mesh_terms: D000328:Adult; D000368:Aged; D001362:Avoidance Learning / Q000502:physiology*; D058443:Catastrophization / Q000209:etiology*; D002908:Chronic Disease; D003071:Cognition; D003469:Culture; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications* / Q000523:psychology*; D019964:Mood Disorders / Q000175:diagnosis / Q000209:etiology*; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D012720:Severity of Illness Index
keywords: anxiety; catastrophizing; chronic migraine; depression; disability; locus of control; migraine