Improvements in headache frequency and disability may be observed in individuals with migraine without changes in pain avoidance or endurance behavior, according to results published in the Journal of Headache and Pain.

The study included participants with episodic (n=90) or chronic (n=38) migraine who were asked to complete the Avoidance-Endurance Questionnaire behavioral subscales, the Pain Disability Index, the Migraine Disability Assessment Scale, and the Hospital Anxiety and Depression Scale. A total of 69 participants who were followed up at 3 and 6 months were evaluated.

Positive relations between avoidance (particularly social avoidance behavior) and pain-related disability were established at baseline, as assessed by the Pain Disability Index (Wald χ2 [1]=32.301; P <.001) and the Migraine Disability Assessment Scale (Wald χ2 [1] =14.387; P <.001) questionnaires. 

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A positive link between social avoidance with the Hospital Anxiety and Depression Scale depression score (Wald χ2 [1]=3.938; P =.047) was also established. In addition, a negative relationship between endurance (especially the humor-distraction subscale) and the Hospital Anxiety and Depression Scale anxiety score (Wald χ2 [1]=6.163; P =.013) was detected. No link was found between avoidance or intensity and intensity or frequency of headache.

At 3 and 6 months after delivery of questionnaires, study participants were re-assessed. Headache frequency, headache intensity, and pain-related disability were all found to be improved (P <.01 for all). Avoidance and endurance were comparable with baseline levels.

“Because of the significant relation of avoidance behaviour with headache-related disability, investigating if interventions that specifically target avoidance behaviour further improve the management of migraine would be worthwhile,” noted the investigators.

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Ruscheweyh R, Pereira D, Hasenbring MI, Straube A. Pain-related avoidance and endurance behaviour in migraine: an observational study. J Headache Pain. 2019;20:9.