Stress Negatively Affects Acute Treatment for Chronic Migraine

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Patients in the stress group had a higher rate of bilaterality, photophobia, and phonophobia.
Patients in the stress group had a higher rate of bilaterality, photophobia, and phonophobia.

High levels of stress may be associated with poor acute treatment outcomes in patients with chronic migraine, according to the results of a recent study published in Pain Medicine.

To evaluate the impact of stress on acute chronic migraine treatment outcomes, 186 patients with chronic migraine were enrolled in the study. Stress was measured with the Korean version of the Brief Encounter Psychosocial Instrument (BEPSI-K), and patients with BEPSI-K scores higher than 2.4 were considered stressed (n=79).

Quality of life and outcomes of acute migraine treatment were measured with the EuroQol Five Dimension Questionnaire Three-Level and the Migraine Assessment of Current Therapy Questionnaire (Migraine-ACT), respectively.

Compared with the nonstress group, the stress group had a significantly higher percentage of patients with poor treatment outcomes (67.1% vs 40.2%; P <.001). In a univariate analysis based on Migraine-ACT scores, female gender (odds ratio [OR], 3.750), number of headache-free days per month (OR, 0.902), and BEPSI-K score (OR, 2.054) were associated with poor acute treatment outcomes. Factors associated with poor acute treatment outcomes in a multivariate analysis included female gender (OR, 3.266), number of headache-free days per month (OR, 0.932), and DEPSI-K score (OR, 1.667).

Patients in the stress group had a higher rate of bilaterality (P =.046), photophobia (P =.028), and phonophobia (P =.03). Mean quality of life scores and outcomes scores were also lower in the stress vs nonstress group.

The researchers explained that the results highlight "an association between stress and the poor outcomes of acute treatment in patients with [chronic migraine]. Moreover, our data suggest that patients with [chronic migraine] may suffer a greater degree of stress," which they noted "should be evaluated carefully in the clinical setting to improve the [quality of life] and to successfully manage patients with [chronic migraine]."

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Reference

Cha MJ, Kim BK, Moon HS, et al. Stress is associated with poor outcome of acute treatment for chronic migraine: A multicenter study [published online November 2, 2017]. Pain Med. doi:10.1093/pm/pnx269

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