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

Abstract 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...

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Main Authors: Janosch Fox, Charly Gaul, Julia Ohse, Nicolina Peperkorn, Joshua Krutzki, Youssef Shiban
Format: Article
Language:English
Published: BMC 2025-07-01
Series:The Journal of Headache and Pain
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Online Access:https://doi.org/10.1186/s10194-025-02101-4
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author Janosch Fox
Charly Gaul
Julia Ohse
Nicolina Peperkorn
Joshua Krutzki
Youssef Shiban
author_facet Janosch Fox
Charly Gaul
Julia Ohse
Nicolina Peperkorn
Joshua Krutzki
Youssef Shiban
author_sort Janosch Fox
collection DOAJ
description Abstract 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.
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spelling doaj-art-5b6de0963d224da48a8508266e4797632025-08-20T04:03:00ZengBMCThe Journal of Headache and Pain1129-23772025-07-0126111810.1186/s10194-025-02101-4Psychological transdiagnostic factors and migraine characteristics as predictors of migraine-related disabilityJanosch Fox0Charly Gaul1Julia Ohse2Nicolina Peperkorn3Joshua Krutzki4Youssef Shiban5Department of Psychology, PFH GoettingenMedical Faculty, University of Duisburg-EssenDepartment of Psychology, PFH GoettingenDepartment of Psychology, PFH GoettingenDepartment of Psychology, PFH GoettingenDepartment of Psychology, PFH GoettingenAbstract 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.https://doi.org/10.1186/s10194-025-02101-4MigraineFear avoidance modelDisabilityPredictorsPsychologicalBiopsychosocial
spellingShingle Janosch Fox
Charly Gaul
Julia Ohse
Nicolina Peperkorn
Joshua Krutzki
Youssef Shiban
Psychological transdiagnostic factors and migraine characteristics as predictors of migraine-related disability
The Journal of Headache and Pain
Migraine
Fear avoidance model
Disability
Predictors
Psychological
Biopsychosocial
title Psychological transdiagnostic factors and migraine characteristics as predictors of migraine-related disability
title_full Psychological transdiagnostic factors and migraine characteristics as predictors of migraine-related disability
title_fullStr Psychological transdiagnostic factors and migraine characteristics as predictors of migraine-related disability
title_full_unstemmed Psychological transdiagnostic factors and migraine characteristics as predictors of migraine-related disability
title_short Psychological transdiagnostic factors and migraine characteristics as predictors of migraine-related disability
title_sort psychological transdiagnostic factors and migraine characteristics as predictors of migraine related disability
topic Migraine
Fear avoidance model
Disability
Predictors
Psychological
Biopsychosocial
url https://doi.org/10.1186/s10194-025-02101-4
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