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Psychological Factors Associated With Chronic Migraine and Severe Migraine-Related Disability: An Observational Study in a Tertiary Headache Center


  • Conflict of Interest: Elizabeth K. Seng, PhD has received research support from the National Institute of Neurological Diseases and Stroke (1K23NS096101-01 PI:Seng) and the International Headache Academy and has served as a consultant to GlaxoSmithKline. Dawn C. Buse, PhD has received grant support and honoraria from Allergan, Avanir, Eli Lilly, the American Headache Society, and the National Headache Foundation. She is an employee of Montefiore Medical Center, which has received research support funded by Allergan, Alder, Avanir, Argus, CoLucid, Electrocore, Labrys, Merck, Dr. Reddy's Laboratories, and Teva, both directly and via grants to the National Headache Foundation. She is on the editorial board of the Current Pain and Headache Reports, Journal of Headache and Pain, Pain Medicine News, and Pain Pathways magazine. Jaclyn Klepper, MA, Sarah J. Mayson, MA, and Amy Grinberg, MA have no conflicts of interest to declare. Brian M. Grosberg, MD has received book royalties from Wiley. Jelena M. Pavlovic, MD, PhD is a consultant for Allergan, Inc. Matthew S. Robbins, MD has received honoraria for educational activities with the American Headache Society, American Academy of Neurology, Medlink, Springer, and book royalties from Wiley. Sarah E. Vollbracht, MD is an employee of the Montefiore Medical Center and the fellowship program director at the Montefiore Headache Center, which has received fellowship funding support from Allergan in the last 12 months. Richard B. Lipton, MD received research support from the NIH: PO1 AG003949 (Program Director), PO1AG027734 (Project Leader), RO1AG025119 (Investigator), RO1AG022374-06A2 (Investigator), RO1AG034119 (Investigator), RO1AG12101 (Investigator), 23NS05140901A1 (Mentor), and K23NS47256 (Mentor), and the National Headache Foundation; serves on the editorial boards of Neurology and Cephalalgia and as senior advisor to Headache, has reviewed for the NIA and NINDS, holds stock options in eNeura Therapeutics (a company without commercial products); serves as consultant, advisory board member, or has received honoraria from: Alder, Allergan, American Headache Society, Autonomic Technologies, Avanir, Boehringer-Ingelheim, Boston Scientific, Bristol Myers Squibb, Colucid, Dr. Reddy's Laboratories, Electrocore, Eli Lilly, eNeura Therapeutics, Informa, Merck, Novartis, Pfizer, Teva, and Vedanta. He receives royalties from Wolff's Headache, 8th Edition, Oxford Press University, 2009.

  • Funding: This research was funded through institutional funds (Yeshiva University) to the first author.



To evaluate the relationships among modifiable psychological factors and chronic migraine and severe migraine-related disability in a clinic-based sample of persons with migraine.


Evidence evaluating relationships between modifiable psychological factors and chronic migraine and severe migraine-related disability is lacking in people with migraine presenting for routine clinical care.


Adults with migraine completed surveys during routinely scheduled visits to a tertiary headache center. Participants completed surveys assessing chronic migraine (meeting criteria for migraine with ≥15 headache days in the past month), severe migraine disability (Migraine Disability Assessment Scale score ≥ 21), and modifiable psychological factors (depressive symptoms [Patient Health Questionnaire-9], anxious symptoms [Generalized Anxiety Disorder-7], Pain Catastrophizing Scale and Headache Specific Locus of Control). Logistic regression evaluated relationships between modifiable psychological factors and chronic migraine and severe migraine disability.


Among 90 eligible participants the mean age was 45.0 (SD = 12.4); 84.8% were women. One-third (36.0%) met study criteria for chronic migraine; half of participants (51.5%) reported severe migraine-related disability. Higher depressive symptoms (OR = 1.99, 95% CI = 1.11, 3.55) and chance HSLC (OR = 1.85, 95% CI = 1.13, 1.43) were associated with chronic migraine. Higher depressive symptoms (OR = 3.54, 95%CI = 1.49, 8.41), anxiety symptoms (OR = 3.65, 95% CI = 1.65, 8.06), and pain catastrophizing (OR = 1.95, 95% CI = 1.14, 3.35), were associated with severe migraine-related disability.


Psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance locus of control were associated with chronic migraine. This study supports the need for longitudinal observational studies to evaluate the relationships among naturalistic variation in psychological factors, migraine-related disability, and migraine chronification.