Pain Acceptance Linked With Reduced Disability, Pain Interference in Migraine

In a cross-sectional study published in Headache, higher levels of pain acceptance were associated with less headache disability and pain interference in overweight women with migraine.¹

Migraine sufferers often avoid triggers and activities thought to precipitate migraine. In line with the fear avoidance model of pain, however, some findings have shown that avoidance can lead to headache disability by reducing pain thresholds and preventing pain habituation.^2,3 In addition, psychological factors have been found to have a greater influence on the fear-avoidance cycle than symptoms like headache severity, suggesting that targeting such factors in patients with migraine may improve outcomes.⁴

In contrast to avoidance-style coping, pain acceptance consists of 2 components: pain willingness — the recognition that pain avoidance efforts tend to be ineffective — and activity engagement, consisting of participation in life activities despite being in pain.⁵

Pain acceptance has been linked with improvements in pain and functioning in individuals with chronic musculoskeletal pain, and recent findings demonstrated that it may also affect headache severity and disability in migraine patients.

The current study examined connections between pain acceptance, headache disability, and headache severity in 126 women with a body mass index (BMI) ≥25 kg/m² who had received a diagnosis of migraine with or without aura.

Using a smartphone application, participants recorded their migraine frequency, pain intensity, and pain interference for 28 days. Pain acceptance was assessed with the 20-item revised Chronic Pain Acceptance Questionnaire, which measures both pain willingness and activity engagement.

The final analysis revealed an independent association between pain willingness and reduced headache disability (P <.001; β = −0.233), and between pain willingness and pain interference (P <.001; β = −0.261) independently of BMI, pain severity, and migraine frequency. However, no such association was found for the activity engagement component (disability: P =.128; β = −0.138; and interference: P =.042; β = −0.154).

These results indicate that “the more accepting participants were of their headache symptoms and related pain, the less it disrupted their ability to live their lives,” said study investigators Dale S. Bond, PhD, and Jason Lillis, PhD, both professors of psychiatry and human behavior at the Warren Alpert Medical School of Brown University. “Newer behavioral and psychological interventions such as Acceptance and Commitment Therapy have successfully increased acceptance and reduced disability for chronic pain patients, and the results of this study suggest the same methods might be helpful for migraine,” they told Clinical Pain Advisor.

Future research in this area should include longitudinal studies to confirm the present findings over the long term and intervention studies to test the efficacy of acceptance-based strategies to reduce migraine pain and disability.

Summary and Clinical Applicability

Results from this study indicate that the pain willingness component of pain acceptance was associated with a reduction in headache disability and pain interference in female migraine patients who were overweight or obese.

Limitations

The cross-sectional design of the study precludes causal inferences, and the generalizability of the results is limited because all participants were women and most were white. 

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References

1. Lillis J, Graham Thomas J, Seng EK, et al. Importance of pain acceptance in relation to headache disability and pain interference in women with migraine and overweight/obesity [published online March 1, 2017]. Headache. doi:10.1111/head.13058
2. Crombez G, Vlaeyen JWS, Heuts P, Lysens R. Pain-related fear is more disabling than pain itself: Evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80(1-2):329-339.
3. Leeuw M, Goossens M, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. J Behav Med. 2007;30(1):77-94. doi:10.1007/s10865-006-9085-0
4. Ocanez KLS, McHugh RK, Otto MW. A metaanalytic review of the association between anxiety sensitivity and pain. Depress Anxiety. 2010;27(8):760-767. doi:10.1002/da.20681
5. McCracken LM, Vowles KE, Eccleston C. Acceptance of chronic pain: Component analysis and a revised assessment method. Pain. 2004;107(1-2):159-166.
6. Thompson M, McCracken LM. Acceptance and related processes in adjustment to chronic pain. Curr Pain Headache Rep. 2011; 15(2):144-51. doi:10.1007/s11916-010-0170-2
7. Dindo L, Recober A, Marchman J, O’Hara MW, Turvey C. One-day behavioral intervention in depressed migraine patients: Effects on headache. Headache. 2014;54(3):528-38.