Optimism, Pessimism, and Migraine: A Cross‐Sectional, Population‐Based Study

Abstract

Background.-Optimism and pessimism are related to several mental health and brain disorders, are significant predictors of physical and psychological health outcomes, and implicated as psychosocial determinants of the pain experience. Despite this promising evidence, limited information is available on optimism and pessimism in headache disorders.Objective.-To evaluate the influence of optimism and pessimism in meeting criteria for migraine and related disability in a population-based sample.Methods.-This is an observational, cross-sectional study. The sample population was selected through a stratified, multistage area probability sample of households, as used by the last Brazilian Census. A validated questionnaire eliciting data on demographics, headache features, migraine-related disability, depression (PHQ-9), anxiety (GAD-7), optimism, and pessimism (life orientation test -revised) was administered to people with migraine and headache-free control participants from the general population in São Paulo, Brazil via trained interviewers. Six hundred individuals were contacted. The odds for having migraine/ no headache diagnosis were calculated by binary logistic regression, and ordinal regression was performed to check associations between migraine-related disability and optimism.Results.-A total of 302 individuals (mean ± SD age: 39.7 ± 12.7; BMI: 26.5 ± 5.9) met inclusion criteria and were included, 140 controls (with no history of headache disorders) and 162 people meeting criteria for migraine (29 with chronic migraine, that is, 15 or more headache days/month). People with migraine were less optimistic and more pessimistic than controls, and endorsed higher levels of anxious and depressive symptoms. Pessimism (OR 95% CI = 1.16 [1.05-1.28], P = .005) and anxiety (OR 95% CI = 1.19 [1.10-1.29], P < .001) were predictors of meeting criteria for migraine, while optimism (β 95% CI = −0.915 [−1.643, −0.188], P = .01) was inversely associated with migraine-related disability.Conclusions.-Optimism and pessimism are associated with migraine and migraine-related disability. These concepts should be further explored in people with migraine with regard to their potential influences on clinical research outcomes and treatments.

The beneficial effect of positive treatment expectations on pharmacological migraine prophylaxis

“…Furthermore, it is in line with the notion that optimism, a general trait towards positively biased predictions of future events, is associated with reduced migraine-related disability. 41 But why is this beneficial effect of expectation on treatment response only evident in CM, and not in EM? One could argue that our observation is the result of a floor effect in patients with EM.…”

“…This finding is in line with previous studies showing that positive expectations are associated with the response to acute interventions 47 and multimodal treatment programs in chronic pain.14 Furthermore, it is in line with the notion that optimism, a general trait towards positively biased predictions of future events, is associated with reduced migraine-related disability. 41 But why is this beneficial effect of expectation on treatment response only evident in CM, and not in EM? One could argue that our observation is the result of a floor effect in patients with EM.…”

Clinical effect of flunarizine combined with duloxetine in the treatment of chronic migraine comorbidity of depression and anxiety disorder

“…Flunarizine is the calcium antagonist of piperidine difluoride derivative, which has a certain therapeutic effect on epilepsy and migraine. But it cannot reduce negative emotions and is not conducive to the control of the disease (Peres et al., 2019 ; Wang et al., 2022 ).…”

“…Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor, which is often used in the treatment of severe depression, diabetic peripheral neuralgia, and female stress urinary incontinence (Gonzalez‐Martinez et al., 2020 ). Studies have found that duloxetine hydrochloride enteric‐coated capsules can effectively relieve anxiety and depression, reduce the frequency of migraine attacks and pain, and improve the quality of life of patients (Liu et al., 2021 ; Peres et al., 2019 ). However, there are few studies on its effects on neuroelectrophysiological indexes and inflammatory indexes.…”

The impact of anxiety and depression on migraine patients’ journey to a tertiary headache center

“…Patients with migraines and comorbid anxiety and/or depression experience higher medical costs when compared to patients with no comorbidities (7) due to resource utilization, including medical visits, diagnostic tests, and therapeutic interventions (8,9). Additionally, migraineurs are less optimistic and more pessimistic than non-migraneurs, which may also influence their medical care seeking (10).…”