Mediator Variables in Headache Research: Methodological Critique and Exemplar Using Self‐Efficacy as a Mediator of the Relationship Between Headache Severity and Disability

Peck, Kelly R.; Smitherman, Todd A.

doi:10.1111/head.12633

Cited by 14 publications

(17 citation statements)

References 36 publications

(69 reference statements)

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“…Our results are in line with Smitherman et al, 42 who suggest that depression, anxiety, and insomnia should be assessed in every treatment-seeking headache patient, particularly those with frequent attacks. 42 Our finding that self-efficacy can mediate treatment effects in chronic headache is in line with Peck and Smitherman, 43 who assessed HMSE as mediator for the relationship between headache severity and disability in a population of predominantly nonchronic headache sufferers. Self-efficacy has also been found to be associated with improvement of outcomes in other chronic pain conditions.…”

Section: Discussionsupporting

confidence: 84%

“…We specifically note the lack of RCTs that carried out prespecified subgroup analysis, which would provide higher-quality evidence, and the lack of theoretical framework of moderator and mediator analyses. 43,48 In this review, there was only one study that conducted prespecified subgroup analysis, and its reporting was difficult to interpret. The authors concluded that the moderator was significantly associated with treatment outcome before, during, and after treatment, but it was not clear if the significance was driven by the difference between placebo and the other 3 treatments across treatment time or the difference within treatment across treatment time.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic factors for chronic headache

et al. 2017

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Objective:To identify predictors of prognosis and trial outcomes in prospective studies of people with chronic headache.Methods:This was a systematic review of published literature in peer-reviewed journals. We included (1) randomized controlled trials (RCTs) of interventions for chronic headache that reported subgroup analyses and (2) prospective cohort studies, published in English, since 1980. Participants included adults with chronic headache (including chronic headache, chronic migraine, and chronic tension-type headache with or without medication overuse headache). We searched key databases using free text and MeSH terms. Two reviewers independently extracted data and assessed the methodologic quality of studies and overall quality of evidence identified using appropriate published checklists.Results:We identified 16,556 titles, removed 663 duplicates, and reviewed 199 articles, of which 27 were included in the review—17 prospective cohorts and 10 RCTs with subgroup analyses reported. There was moderate-quality evidence indicating that depression, anxiety, poor sleep and stress, medication overuse, and poor self-efficacy for managing headaches are potential prognostic factors for poor prognosis and unfavorable outcomes from preventive treatment in chronic headache. There was inconclusive evidence about treatment expectations, age, age at onset, body mass index, employment, and several headache features.Conclusions:This review identified several potential predictors of poor prognosis and worse outcome postinterventions in people with chronic headache. The majority of these are modifiable. The findings also highlight the need for more longitudinal high-quality research of prognostic factors in chronic headache.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Prognostic factors for chronic headache

et al. 2017

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“…These results underscore the notion that disability in migraine is attributable to more than the increased pain severity that often accompanies allodynia. 6 Consistent with recent calls for increased exploration of mechanistic variables and utilization of contemporary mediation models within headache outcome research, 36 we sought to quantify whether stress mediated the allodynia-disability relationship while controlling for pain severity. The mediation analysis revealed that the relationship between allodynia and disability was partially driven by stress.…”

Section: Discussionmentioning

confidence: 99%

Allodynia and Disability in Migraine: The Mediating Role of Stress

2020

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Objective.-This study sought to investigate the relationship between allodynia, psychological variables, and disability among individuals with migraine. Background.-A growing body of research views migraine as a condition of stress-related physiological dysregulation. Cutaneous allodynia is one manifestation of this dysregulation and affects a majority of individuals with migraine, though it is typically discussed in the context of headache pathophysiology. Stress, like allodynia, is implicated in the development of central sensitization and migraine progression. However, the contributions of stress and related psychological factors in allodynia and resulting disability remain largely unknown. Methods.-A cross-sectional study at a Southern U.S. university queried young adults with migraine regarding headache symptoms, disability, allodynia symptom frequency, and psychological variables using validated measures. Relations among allodynia and psychological variables of relevance were examined, including the association between allodynia and disability after controlling for pain severity. Subsequently, we assessed whether stress mediated the relationship between allodynia and disability. Results.-The final sample consisted of 147 young adults (87.8% [129/147] female, mean age = 19.0 ± 2.4) with an average headache frequency of 9.9 days per month (SD = 5.9). Increases in allodynia showed small associations with increases in stress, (r = 0.26, P = .001), fear of pain (r = 0.22, P = .008), and headache-related disability (r = 0.18, P = .003); and a small association with reduced self-efficacy (r = −0.16, P = .049). Allodynia significantly predicted disability even after controlling for pain severity (∆R 2 = 0.02, P = .040), and the allodynia-disability relationship was mediated by stress (point estimate = 0.10, 95% CI [0.02-0.21]), such that as allodynia severity increased, stress increased and subsequent disability worsened. Conclusions.-This study establishes meaningful relationships between allodynia and psychological variables of importance to headache self-management and adaptive coping. Allodynia exerts some effect on disability independent of pain itself, and this relationship is partially driven by stress. This study highlights the potential role of the stress response among those with allodynia, and further research is needed to determine if migraine interventions that target maladaptive stress responses may reduce disability by impeding the feedforward loop of allostatic load.

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“…28,29 Though review of existing publications reveals a paucity of research directly examining associations between self-efficacy and nonpharmacological treatment adherence, available data indicate that greater levels of self-efficacy are associated with greater adherence to both preventative 30 and acute pharmacological treatment. 31 Further, self-efficacy mediated the association between pain severity and disability 32,33 and may be an important mechanism in pain reduction. 34 For example, French et al 35 found that self-efficacy scores were positively associated with use of adaptive coping efforts to both prevent and manage headache episodes among 146 individuals with diagnoses of tension-type headache or comorbid tension and migraine diagnoses.…”

Section: Barriers Tomentioning

confidence: 99%

Barriers to Behavioral Treatment Adherence for Headache: An Examination of Attitudes, Beliefs, and Psychiatric Factors

et al. 2018

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Background/Objectives Nonpharmacological interventions such as biofeedback, cognitive behavioral therapy, and relaxation techniques are Level-A evidence-based treatments for headache. The impact of these interventions is often equivalent to or greater than pharmacological interventions, with fewer side effects. Despite such evidence, the rate of participation in nonpharmacological interventions for headache remains low. Once obstacles to optimizing use of behavioral interventions such as local access to nonpharmacological treatment and primary headache providers are traversed, identification of barriers contributing to low adherence is imperative given the high levels of disability and cost associated with treating headache disorders. In this review of factors in adults associated with underuse of nonpharmacological interventions, we discuss psychological factors relevant to participation in nonpharmacological treatment, including attitudes and beliefs, motivation for change, awareness of triggers, locus of control, self-efficacy, acceptance, coping styles, personality traits, and psychiatric comorbidities associated with treatment adherence. Finally, future prospects and approaches to optimizing treatment matching and minimizing adherence issues are addressed. Methods An interdisciplinary team conducted this narrative review. Neuropsychologists conducted a literature search during the month of July 2017 using a combination of the keywords (“headache” or “migraine”) and (“adherence” or “compliance”) or “barriers to treatment” or various “psychological factors” discussed in this narrative review. Content experts, a psychiatrist, and a complementary and integrative health specialist provided additional commentary and input to this narrative review resulting in integration of additional noteworthy studies, book chapters and books. Results Various psychological factors such as attitudes and beliefs, lack of motivation, poor awareness of triggers, external locus of control, poor self-efficacy, low levels of acceptance and engagement in maladaptive coping styles can contribute to non-adherence. Conclusions To maximize adherence, clinicians can assess and address an individual’s level of treatment acceptance, beliefs that may present as barriers, readiness for change, locus of control, self-efficacy and psychiatric comorbidities. Identification of barriers to adherence as well as the application of relevant assessment and intervention techniques have the potential to facilitate adherence and ultimately improve treatment success.

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Mediator Variables in Headache Research: Methodological Critique and Exemplar Using Self‐Efficacy as a Mediator of the Relationship Between Headache Severity and Disability

Cited by 14 publications

References 36 publications

Prognostic factors for chronic headache

Prognostic factors for chronic headache

Allodynia and Disability in Migraine: The Mediating Role of Stress

Barriers to Behavioral Treatment Adherence for Headache: An Examination of Attitudes, Beliefs, and Psychiatric Factors

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