Abstract
BackgroundThe role of avoidance and endurance behaviour is well established in chronic musculoskeletal pain, but less is known about its significance in migraine.MethodsThe Avoidance-Endurance Questionnaire behavioural subscales, the Pain Disability Index (PDI), the Migraine Disability Assessment Scale (MIDAS) and the Hospital Anxiety and Depression Scale (HADS) were obtained from 128 migraine patients (90 episodic, 38 chronic). Sixty nine of them were re-evaluated after 3–6 months.ResultsAt baseline, there were positive relations between avoidance (especially social avoidance behaviour) and pain-related disability as assessed by the PDI (Wald χ2 [1] = 32.301, p < 0.001) and the MIDAS (Wald χ2 [1] = 14.387, p < 0.001). A negative relation of endurance behaviour with PDI scores did not survive multiple regression analysis. In addition, there was a positive relation of social avoidance with the HADS depression score (Wald χ2 [1] = 3.938, p = 0.047) and a negative relation of endurance (especially the humour-distraction subscale) with the HADS anxiety score (Wald χ2 [1] = 6.163, p = 0.013). Neither avoidance nor endurance were related to headache intensity or frequency, or to a diagnosis of episodic vs. chronic migraine. 3–6 months after treatment at our headache centre, headache frequency, intensity and pain-related disability were significantly improved (all p < 0.01) while avoidance and endurance were unchanged.ConclusionsThis indicates that improvement in headache frequency and disability can be achieved in the absence of changes in avoidance or endurance behaviour. However, because of its significant link to headache-related disability, avoidance behaviour (especially social avoidance) should be investigated as a potential additional target of migraine therapy.
Highlights
The role of avoidance and endurance behaviour is well established in chronic musculoskeletal pain, but less is known about its significance in migraine
There were medium to high positive correlations between avoidance scores and headache-related disability (PDI and Migraine Disability Assessment Scale (MIDAS) scores), and small to medium sized negative correlations between the Pain Disability Index (PDI) and Avoidance-Endurance Questionnaire (AEQ) endurance scores (AEQ-BES and AEQ-PPS, Table 3)
Multiple regression analysis revealed a significant relation between both, the PDI and the MIDAS scores, and the AEQ-ASAS (Wald χ2 [1] = 32.301 and 14.387, both p < 0.001) but not with the AEQ endurance scores (p > 0.1)
Summary
The role of avoidance and endurance behaviour is well established in chronic musculoskeletal pain, but less is known about its significance in migraine. The fear-avoidance model as described by Vlaeyen [1] is well established among the psychological mechanisms contributing to the transition from acute to chronic musculoskeletal pain. This model describes how exaggerated fear/anxiety in response to or anticipation of pain (e.g. the fear that physical activity will induce pain) leads to physical and social avoidance behaviour, physical deconditioning and depression, resulting in more pain and disability. Another study reported a significant association between anxiety and avoidance behaviour in migraine [6]. The relationship of avoidance and endurance behaviour to headache-related disability has not been directly examined, and no longitudinal studies on avoidance and endurance behaviour in headache have been published
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