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Acceptance, Psychiatric Symptoms, and Migraine Disability: An Observational Study in a Headache Center
Author(s) -
Seng Elizabeth K.,
Kuka Alexander J.,
Mayson Sarah Jo,
Smitherman Todd A.,
Buse Dawn C.
Publication year - 2018
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13325
Subject(s) - migraine , depression (economics) , anxiety , medicine , center for epidemiologic studies depression scale , psychiatry , physical therapy , chronic migraine , demographics , depressive symptoms , demography , sociology , economics , macroeconomics
Objective To evaluate relationships between psychiatric symptoms, acceptance, and migraine‐related disability in a sample of people with migraine presenting at a tertiary care headache center. Background Migraine 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. Methods Ninety patients with physician‐diagnosed migraine completed surveys assessing demographics, headache symptoms, severe migraine‐related disability (Migraine Disability Assessment Scale total score dichotomized at ≥ 21), depression (Patient Health Questionnaire‐9) and anxiety symptoms (Generalized Anxiety Disorder‐7), and acceptance (Chronic Pain Acceptance Questionnaire; subscales: Pain Willingness and Activity Engagement). Results Participants (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). Conclusion Results 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.