Migraine Disability, Pain Catastrophizing, And Headache Severity Are Associated With Evoked Pain And Targeted By Mind-Body Therapy

Abstract

AbstractMeta-analysis suggests migraine patients are no more sensitive to experimentally evoked pain than healthy controls. At the same time, studies have linked some migraine symptoms to Quantitative Sensory Testing (QST) profiles. Unfortunately, previous studies associating migraine symptoms and QST have important methodological shortcomings, stemming from inappropriate statistics, small sample sizes, and frequent use of univariate statistics for multivariate research questions. In the current study we seek to address these limitations by using a large sample of episodic migraine patients (n=103) and a multivariate analysis that associates pain ratings from many thermal intensities simultaneously with 12 clinical measures ranging from headache frequency to sleep abnormalities. We identified a single dimension of association between QST and migraine symptoms that relates to pain ratings for all stimulus intensities and a subset of migraine symptoms relating to disability (Headache Impact Trauma 6 and Brief Pain Inventory interference), catastrophizing (Pain Catastrophizing Scale), and pain severity (average headache pain, Brief Pain Inventory severity, and Short Form McGill Pain Questionnaire 2). Headache frequency, allodynia, affect, and sleep disturbances were unrelated to this dimension. Consistent with previous research, we did not observe any difference in QST ratings between migraine patients and healthy controls. Additionally, we found that the linear combination of symptoms that related to QST were modified by mind-body therapy. These results suggest that QST has a selective relationship with pain symptoms even in the absence of between-subjects differences between chronic pain patients and healthy controls.HighlightsExperimentally evoked pain ratings have been linked to migraine symptoms, though there are methodological shortcomingsWe find evoked pain ratings are related to disability, pain catastrophizing, and pain severity, but not to headache frequency, affect, nor sleep disturbancesEvoked pain and symptoms relate even in the absence of pain sensitivity differences between patients and healthy controlsMind-body therapy altered symptoms that related to evoked painExperimentally evoked pain should be used to study specific ensembles of symptoms, even when pain ratings do not differ between patients and healthy controls