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

ObjectiveTo evaluate relationships between psychiatric symptoms, acceptance, and migraine-related disability in a sample of people with migraine presenting at a tertiary care headache center. BackgroundMigraine 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. MethodsNinety patients with physician-diagnosed migraine completed surveys assessing demographics, headache symptoms, severe migraine-related disability (Migraine Disability Assessment Scale total score dichotomized at21), depression (Patient Health Questionnaire-9) and anxiety symptoms (Generalized Anxiety Disorder-7), and acceptance (Chronic Pain Acceptance Questionnaire; subscales: Pain Willingness and Activity Engagement). ResultsParticipants (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). ConclusionResults 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.