Migraine characteristics are associated with impaired functioning and quality of life (Fn/QoL), but the impact of other factors on Fn/QoL in headache patients is largely unexplored. We examined catastrophizing, comorbid anxiety/depression and migraine characteristics as related to Fn/QoL, and explored the consistency of these relationships across five Fn/QoL measures. We evaluated 232 frequent migraine sufferers for comorbid psychiatric diagnosis, and they completed anxiety, depression and catastrophizing measures, recorded migraine characteristics in a diary and completed five Fn/QoL measures (four self-report questionnaires, one diary disability measure). Backward regression revealed catastrophizing and severity of associated symptoms (photophobia, phonophobia, nausea) independently predicted Fn/QoL across all five measures (β weights 0.16-0.50, all P < 0.01). This is the first demonstration that a psychological response to migraines (catastrophizing) is associated with impaired Fn/QoL independent of migraine characteristics and other demographic and psychological variables. Severity of associated symptoms also emerged as an important contributor to Fn/QoL.

OBJECTIVE-This study's purpose was to identify the areas that people find most difficult in living with migraines and, in that regard, what kinds of assistance would be most helpful to them and to other people who have migraine headaches.STUDY DESIGN-Four focus groups, each consisting of 4 to 8 participants, were held. Discussions, which were recorded and organized according to category and theme, focused on problems in living with migraines and effective treatment of migraines.POPULATION-Participants were 24 people who had been experiencing 1 to 2 migraines a month, each lasting 1 to 2 days, for at least 6 months. RESULTS-Five themes emerged:(1) impact on family, (2) misunderstanding by others, (3) effect on work, (4) physician care issues, and (5) issues related to medical insurance and drug companies. A majority of participants identified early treatment as the most important consideration for new migraine sufferers. Many participants preferred to have a relationship with their physicians in which they developed a treatment plan together rather than receiving generic educational materials. CONCLUSIONS-Resultssuggest that patients are interested in understanding their migraines and securing relevant information in addition to obtaining pain relief. Patients desired collaborative relationships with their physicians and a team approach to treatment. Suggestions for physicians who treat patients who have migraines are reviewed. KeywordsMigraine; focus groups; physician-patient relations KEY POINTS FOR CLINICIANS• Migraine sufferers said they would prefer a collaborative relationship with their physician and a team approach to therapy.• Patients reported that they often felt dismissed by their physicians, frustrated by insurance and drug companies, and misunderstood by their loved ones.

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