Depressive Symptoms and Insecure Attachment as Predictors of Disability in a Clinical Population of Patients With Episodic and Chronic Migraine


  • Paolo Rossi PhD,

  • Giorgio Di Lorenzo MD,

  • Maria Grazia Malpezzi MD,

  • Cherubino Di Lorenzo MD,

  • Francesco Cesarino MD,

  • Jessica Faroni MD,

  • Alberto Siracusano MD,

  • Alfonso Troisi MD

  • Headache Clinic, INI Grottaferrata (Drs. Rossi, Lorenzo, Cesarino, Faroni); Department of Neuroscience, University of Rome “Tor Vergata” (Drs. Lorenzo, Malpezzi, Siracusano, Troisi).

Address all correspondence to Dr. Paolo Rossi, Via Suvereto 250, 00139, Rome, Italy.


Objectives.—To define predictors of migraine-related disability in patients with episodic and chronic migraine referred to a specialty migraine clinic, focusing on depressive symptoms and insecure attachment style that, because of their association with responses to pain and physical illness, might be predictive of greater migraine-related disability.

Background.—The Migraine Disability Assessment questionnaire (MIDAS) has proved to be a reliable and easy-to-use instrument to assess migraine-related disability. As clinicians are increasingly using MIDAS in their diagnostic and treatment decisions for patient care, an understanding of the factors influencing migraine-related disability is essential for a rationale use of such an instrument.

Methods.—Two-hundred patients suffering from episodic migraine without aura (EM), and chronic migraine (CM) with and without medication overuse, and referred to a specialty headache clinic were evaluated using the MIDAS, the Beck Depression Inventory (BDI), and the Attachment Style Questionnaire (ASQ). Diagnosis of episodic and chronic migraine was operationally defined according to the International Headache Society (IHS) and Silberstein–Lipton criteria.

Results.—Multiple regression analysis showed that, in the total sample, disability was higher in those patients with CM, more severe depressive symptoms, an insecure style of attachment (as reflected by a lower score on the ASQ confidence scale), and experiencing more severe headache pain intensity. In the subgroup of patients with episodic migraine, an insecure style of attachment emerged as the most significant predictor of disability (other significant predictors were female sex and number of headache days per month). In contrast, in the subgroup of patients with CM, the only significant predictor of the total MIDAS score was a greater severity of depressive symptoms.

Conclusions.—Our findings demonstrate the relevance of attachment style, an enduring psychological trait not evaluated in previous studies, in influencing the disability level in patients with migraine and confirm the role of comorbid depressive symptoms in modulating the impact of migraine on every day functioning.