Pain Catastrophizing in Women With Migraine and Obesity
Objective/Background.—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, 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.
An ever-expanding body of evidence supports a comorbid relationship between obesity and migraine. Research demonstrating that obesity increases the risk for both having migraine (particularly in those of reproductive age) and experiencing more frequent and severe attacks has prompted growing interest in factors to help elucidate this relationship. Along with theories regarding common physiologic processes (eg, inflammation) and overlapping risk behaviors (eg, low physical activity), it is hypothesized that shared psychological factors may be important in the connection between obesity and migraine. Specifically, higher levels of pain catastrophizing have been associated with both obesity and increased pain in persons with osteoarthritis pain. Catastrophizing may also play an important role in the migraine obesity relationship.
Pain catastrophizing is a negative cognitive and affective set activated in response to anticipated or actual pain. Individuals who catastrophize experience difficulty in inhibiting thoughts about their pain (rumination), exaggerate and worry about the negative consequences of pain (magnification), and believe there is nothing they can do to alleviate the pain (helplessness). Across a variety of pain and other chronic medical disorders, catastrophizing is consistently associated with increased pain experience and reporting, associated disability and impaired health-related quality of life, increased pain behavior, greater use of health-care services, and longer hospital stays. Among individuals with migraine, catastrophizing is associated with more frequent migraine attacks/chronicity, poorer treatment response, increased medical consultation, impaired functioning, and reduced health-related quality of life.
Although pain catastrophizing appears to be adversely associated with severity, impairment, and treatment outcomes in migraine and obesity, catastrophizing has not been examined in individuals with both obesity and migraine. Thus, the current study aimed to conduct exploratory analysis of the relationship of catastrophizing with obesity and migraine in women with both conditions. Specifically, we sought to: (1) identify the percentage of participants who have clinically relevant levels of catastrophizing; (2) compare demographic (age, race/ethnicity, and education level), anthropometric (body mass index [BMI]), migraine (attack frequency, duration, and pain severity, headache impact, cutaneous allodynia, headache management self-efficacy), and psychological (depression, anxiety) characteristics in participants with and without clinical levels of catastrophizing; and (3) evaluate associations of catastrophizing with migraine characteristics in all participants, controlling for the effects of weight status.
Abstract and Introduction
Abstract
Objective/Background.—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, 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.
Introduction
An ever-expanding body of evidence supports a comorbid relationship between obesity and migraine. Research demonstrating that obesity increases the risk for both having migraine (particularly in those of reproductive age) and experiencing more frequent and severe attacks has prompted growing interest in factors to help elucidate this relationship. Along with theories regarding common physiologic processes (eg, inflammation) and overlapping risk behaviors (eg, low physical activity), it is hypothesized that shared psychological factors may be important in the connection between obesity and migraine. Specifically, higher levels of pain catastrophizing have been associated with both obesity and increased pain in persons with osteoarthritis pain. Catastrophizing may also play an important role in the migraine obesity relationship.
Pain catastrophizing is a negative cognitive and affective set activated in response to anticipated or actual pain. Individuals who catastrophize experience difficulty in inhibiting thoughts about their pain (rumination), exaggerate and worry about the negative consequences of pain (magnification), and believe there is nothing they can do to alleviate the pain (helplessness). Across a variety of pain and other chronic medical disorders, catastrophizing is consistently associated with increased pain experience and reporting, associated disability and impaired health-related quality of life, increased pain behavior, greater use of health-care services, and longer hospital stays. Among individuals with migraine, catastrophizing is associated with more frequent migraine attacks/chronicity, poorer treatment response, increased medical consultation, impaired functioning, and reduced health-related quality of life.
Although pain catastrophizing appears to be adversely associated with severity, impairment, and treatment outcomes in migraine and obesity, catastrophizing has not been examined in individuals with both obesity and migraine. Thus, the current study aimed to conduct exploratory analysis of the relationship of catastrophizing with obesity and migraine in women with both conditions. Specifically, we sought to: (1) identify the percentage of participants who have clinically relevant levels of catastrophizing; (2) compare demographic (age, race/ethnicity, and education level), anthropometric (body mass index [BMI]), migraine (attack frequency, duration, and pain severity, headache impact, cutaneous allodynia, headache management self-efficacy), and psychological (depression, anxiety) characteristics in participants with and without clinical levels of catastrophizing; and (3) evaluate associations of catastrophizing with migraine characteristics in all participants, controlling for the effects of weight status.
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