Different effects of migraine associated features on disability and psychiatric conditions in patients with migraine without aura: a multicenter observational cohort study

Abstract

Abstract Background: Migraine is a multifactorial brain disorder characterized by recurrent disabling headaches and their associated features. Several studies have suggested that these features are related to migraine disabilities and psychiatric conditions. However, differences in the impact of each associated feature on migraine disability or psychiatric conditions remain unclear. This study aimed to assess the impact of migraine-associated features on disability and psychiatric conditions in patients with migraine. Methods: We enrolled patients with migraine without aura (MwoA) to exclude those with migraine without headache and to avoid the influence of medication overuse headache, which is commonly associated with chronic migraine. We assessed the impact of associated features on disability or psychiatric conditions using multivariate logistic regression analyses. Associated symptoms included nausea, vomiting, photophobia, phonophobia, osmophobia, and allodynia. Migraine disability and psychiatric conditions were determined using the Headache Impact Test (HIT-6), Visual Analog Scale (VAS), Generalized Anxiety Disorder 7-item scale (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). Results: In total, 1103 patients with MwoA were enrolled in this study. One hundred twenty-five patients were excluded from the study because of missing data. Finally, 939 patients with MwoAs were included in this study. On multivariate logistic regression analyses, nausea (odd ratios [OR] 1.87, confidence interval [CI]: 1.37-2.54), vomiting (OR 1.57, CI: 1.11-2.23), photophobia (OR 1.67, CI: 1.18-2.35), and allodynia (OR 1.56, CI: 1.06-2.28) were independent positive predictors of higher HIT-6 scores, and nausea (OR 1.72, CI: 1.22-2.43), vomiting (OR 1.84, CI: 1.29-2.63), phonophobia (OR 1.58, CI: 1.10-2.25), photophobia (OR 1.49, CI: 1.07-2.08), and allodynia (OR 1.81, CI: 1.24-2.66) were independent positive predictors of higher VAS score. Nausea (OR 1.49, CI: 1.09-2.02), phonophobia (OR 2.00, CI: 1.42-2.82), and allodynia (OR 1.81, CI: 1.24-2.63) were independent positive predictors of GAD-7 score. Nausea (OR 1.66, CI: 1.21-2.28), phonophobia (OR 1.49, CI: 1.05-2.11), and allodynia (OR 1.68, CI: 1.16-2.45) were independent positive predictors and vomiting (OR 0.54, CI: 0.37-0.78) was an independent negative predictor of PHQ-9 score. Conclusions: Our results suggest that nausea, vomiting, photophobia, phonophobia, and osmophobia have distinct effects on migraine disability and psychiatric conditions. Understanding these differences can aid in personalized management of patients with MwoA.