Clinical Pain Catastrophizing in Women With Migraine and Obesity

Abstract

Objective/Background Obesity is related to migraine. Maladaptive pain coping strategies (e.g., 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 Headache Impact Test (HIT-6), Allodynia Symptom Checklist (ASC-12), Headache Management Self-Efficacy Scale (HMSE), and assessments for depression (CES-D) and anxiety (GAD-7) were also administered. Using PCS scores and Body Mass Index (BMI) as predictors in linear regression, we modeled a series of headache features (i.e., headache days, HIT-6, etc.) as outcomes. Results One-quarter (25.7%;95%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/m2, p=0.035), longer migraine attack duration(160.8±145.0 vs. 97.5±75.2 hours/month, p=0.038), higher HIT-6 scores(68.7±4.6 vs. 64.5±3.9, p<0.001), more allodynia(7.0±4.1 vs. 4.5±3.5, p<0.003), depression(25.4±12.4 vs. 13.3±9.2, p<0.001), and anxiety(11.0±5.2 vs. 5.6±4.1, p<0.001), and lower self-efficacy(80.1±25.6 vs. 104.7±18.9, p<0.001) compared to participants without clinical catastrophizing. The odds of chronic migraine were nearly 4-fold greater in those with (n=8/29.6%) versus without (n=8/10.3%) clinical catastrophizing (OR=3.68;95%CI=1.22–11.10, p=0.021). In all participants, higher PCS scores were related to more migraine days(β=0.331, p=0.001), longer attack duration(β=0.390, p<0.001), higher HIT-6 scores(β=0.425, p<0.001), and lower HMSE scores (β=−0.437, p<0.001). Higher BMI, but not higher PCS scores, was related to more frequent attacks (β=−0.203, p=0.044). 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.

Lower inhibitory control interacts with greater pain catastrophizing to predict greater pain intensity in women with migraine and overweight/obesity

“…These findings build on previous research showing that higher levels of pain catastrophizing are associated with migraine attacks that are more severe and disabling [5–7, 37] by highlighting the potential contribution of poorer inhibitory control. This contribution seems to be particularly important in the context of degree of pain intensity within an acute attack.…”

“…The present study advances previous work focused on catastrophizing and/or inhibitory control in the context of pain [5–10] by demonstrating the interaction of these variables in relation to frequency, duration, and intensity of a specific pain condition (migraine). Further, our examination of the relationship between inhibitory control and specific components of pain catastrophizing (e.g., rumination) provides greater insight into the inhibitory control-pain catastrophizing link.…”

“…PCS total scores range from 0 to 52, with higher scores indicating greater pain catastrophizing. The PCS has established reliability and construct validity and has previously been used to evaluate levels of pain catastrophizing in individuals with migraine [3, 5, 7, 24]. …”

“…It is important to note that initial onset of migraine and use of preventative or abortive medications during the headache monitoring period were not associated with pain catastrophizing (total or subscale scores) or inhibitory control, and were therefore not included as covariates. Additional covariates included, depression and anxiety, to enable clearer examination of the potential influence of pain catastrophizing, independently or in conjunction with inhibitory control, and BMI, due its known association with pain catastrophizing [5, 31] and inhibitory control [32, 33]. Separate linear regression models were conducted to examine the independent and joint associations of pain catastrophizing (total score and subscales) and inhibitory control (Stroop Color Word RT) with each of the migraine severity components (i.e.…”

“…Psychological factors, particularly those specific to pain, are known to contribute to greater migraine severity (i.e., pain intensity, attack frequency, and duration). Specifically, pain catastrophizing, which is defined as a negative mental set in response to pain involving difficulty inhibiting pain related thoughts (rumination), exaggerating the negative consequences of pain (magnification), and negatively evaluating one’s ability to cope with pain (helplessness) [3, 4], is associated with migraine attacks that are more frequent, severe, and longer in duration, and with greater headache-related disability and impairments in quality of life [5–7]. Additionally, individuals with clinically significant levels of pain catastrophizing are at greater risk for chronic migraine [5].…”