Psychological transdiagnostic factors and migraine characteristics as predictors of migraine-related disability.

Background: Migraine is a prevalent primary headache disorder that significantly impairs daily life. Research on factors contributing to migraine-related disability remains limited, particularly from a biopsychosocial perspective. This study investigated whether transdiagnostic psychological factors, as proposed by the Fear Avoidance Model (FAM), contribute to migraine-related disability beyond migraine symptoms.

Methods: In this cross-sectional analysis of selected baseline data from an ongoing randomized controlled trial, data from N = 158 individuals with migraine reporting ≥ 4 migraine days per month were examined. Data was collected through an online survey, including sociodemographic and clinical characteristics as well as responses to standardized questionnaires (DASS, PCS, FAMI, HIT-6). A hierarchical multiple linear regression analysis was conducted, including independent variables in two blocks: (1) sociodemographic factors and migraine symptoms, and (2) FAM factors (pain catastrophizing, fear of attacks, depressiveness). Disability, the dependent variable, was assessed using the HIT-6 questionnaire. Additionally, mediation analyses were conducted to investigate the potential mediating role of pain catastrophizing in the relationship between pain intensity or attack frequency and disability.

Results: A total of N = 158 participants were included in the analysis. Hierarchical regression analysis showed that sociodemographic and migraine symptoms accounted for 49% of the variance in disability (R²_adj = 0.49, p < 0.001). The inclusion of FAM factors significantly increased the explained variance to 62% (R²_adj = 0.62, p < 0.001; ΔR²_adj= 0.13, p < 0.001), indicative of a high goodness-of-fit. Independent predictors included gender (ß = -0.15, p = 0.007), age (ß = 0.11, p = 0.029), maximum pain intensity (ß = 0.46, p < 0.001), pain catastrophizing (ß = 0.26, p < 0.001), and depressiveness (ß = 0.13, p = 0.047). Mediation analyses revealed that pain catastrophizing (ß = 0.35, p < 0.001) mediated the relationship between pain intensity (ß = 0.47, p < 0.001) and disability (R² = 0.62, p < 0.001), whereas no mediation effect was observed for attack frequency as independent variable (X→Y: ß = -0.05, p = 0.44; X→ M: ß = -0.07, p = 0.26; M → Y: ß = 0.51, p < 0.001).

Conclusion: The findings underscore the significant role of transdiagnostic psychological factors in migraine-related disability beyond migraine and sociodemographic characteristics. Pain catastrophizing emerged as an important mediator between pain experience and disability, which is in line with the assumptions of the FAM.

Trial registration: German Clinical Trials Register (DRKS), DRKS-ID: DRKS00033893.