Acceptance, Psychiatric Symptoms, and Migraine Disability: An Observational Study in a Headache Center.

Objective: To evaluate relationships between psychiatric symptoms, acceptance, and migraine‐related disability in a sample of people with migraine presenting at a tertiary care headache center. Background: Migraine is a chronic disease that can be severely disabling. Despite a strong theoretical basis and evidence in other pain conditions, little is known about relationships between acceptance, psychiatric symptoms, and migraine‐related disability. Methods: Ninety patients with physician‐diagnosed migraine completed surveys assessing demographics, headache symptoms, severe migraine‐related disability (Migraine Disability Assessment Scale total score dichotomized at ≥ 21), depression (Patient Health Questionnaire‐9) and anxiety symptoms (Generalized Anxiety Disorder‐7), and acceptance (Chronic Pain Acceptance Questionnaire; subscales: Pain Willingness and Activity Engagement). Results: Participants (77.8% white, non‐Hispanic; 85.6% women; and 50.0% with a graduate level education) reported an average headache pain intensity of 6.7/10 (SD = 2.0). One‐third (36.0%) reported chronic migraine, and half (51.5%) reported severe migraine‐related disability. Lower acceptance was associated with severe migraine‐related disability, t(54) = 4.13, P < .001. Higher activity engagement was associated with lower average headache pain intensity (r = −.30, P = .011). Higher acceptance was associated with lower levels of depression (r = −.48, P < .001) and anxiety symptoms (r = −.37, P = .003). Pain willingness and activity engagement serially mediated relationships between depression symptoms and severe migraine‐related disability (indirect effect = 0.05, 95% CI = 0.01, 0.15), and between anxiety symptoms and severe migraine‐related disability (indirect effect = 0.12, 95% CI = 0.02, 0.31). Conclusion: Results provided preliminary support for a theoretical pathway by which psychiatric symptoms may influence migraine‐related disability, in part, through their relationships with pain willingness and activity engagement. [ABSTRACT FROM AUTHOR]