Abstract
BackgroundPain catastrophizing (PC) is associated with more severe and disabling migraine attacks. However, factors that moderate this relationship are unknown. Failure of inhibitory control (IC), or the ability to suppress automatic or inappropriate responses, may be one such factor given previous research showing a relationship between higher PC and lower IC in non-migraine samples, and research showing reduced IC in migraine. Therefore, we examined whether lower IC interacts with increased PC to predict greater migraine severity as measured by pain intensity, attack frequency, and duration.MethodsWomen (n = 105) aged 18–50 years old (M = 38.0 ± 1.2) with overweight/obesity and migraine who were seeking behavioral treatment for weight loss and migraine reduction completed a 28-day smartphone-based headache diary assessing migraine headache severity. Participants then completed a modified computerized Stroop task as a measure of IC and self-report measures of PC (Pain Catastrophizing Scale [PCS]), anxiety, and depression. Linear regression was used to examine independent and joint associations of PC and IC with indices of migraine severity after controlling for age, body mass index (BMI) depression, and anxiety.ResultsParticipants on average had BMI of 35.1 ± 6.5 kg/m2and reported 5.3 ± 2.6 migraine attacks (8.3 ± 4.4 migraine days) over 28 days that produced moderate pain intensity (5.9 ± 1.4 out of 10) with duration of 20.0 ± 14.2 h. After adjusting for covariates, higher PCS total (β = .241, SE = .14, p = .03) and magnification subscale (β = .311, SE = .51, p < .01) scores were significant independent correlates of longer attack duration. IC interacted with total PCS (β = 1.106, SE = .001, p = .03) rumination (β = 1.098, SE = .001, p = .04), and helplessness (β = 1.026, SE = .001, p = .04) subscale scores to predict headache pain intensity, such that the association between PC and pain intensity became more positive at lower levels of IC.ConclusionsResults showed that lower IC interacted with higher PC, both overall and specific subcomponents, to predict higher pain intensity during migraine attacks. Future studies are needed to determine whether interventions to improve IC could lead to less painful migraine attacks via improvements in PC.
Highlights
Pain catastrophizing (PC) is associated with more severe and disabling migraine attacks
Participants reported having a migraine attack on 8 days over the 28-day monitoring period and rated the maximum pain intensity per attack on average as moderate or 6 out of 10
This study examined whether pain catastrophizing interacted with objective measures of inhibitory control to predict migraine severity components among women with migraine and overweight/obesity
Summary
Pain catastrophizing (PC) is associated with more severe and disabling migraine attacks. Migraine is a prevalent neurologic disease characterized by severe recurrent headache pain [1] and is associated with substantial functional and quality of life impairments [2] Psychological factors, those specific to pain, are known to contribute to greater migraine severity (i.e., pain intensity, attack frequency, and duration). Lower inhibitory control may make it more difficult for participants to control pain-related thoughts, resulting in thoughts that are more uncontrollable This notion is supported by findings in one study of adolescents that found that lower inhibitory control, as rated by a self-report questionnaire, was associated with higher levels of pain catastrophizing [8]. These studies were not conducted in the context of migraine
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