Perceived stress and pain severity in individuals with chronic migraine: A longitudinal cohort study using daily prospective diary data

Abstract

Objective: We aimed to describe patterns of peak attack severity from day-to-day, and in relation to same-day perceived stress, in individuals with chronic migraine (CM).

Background: Although changes in perceived stress are often believed to trigger attacks, little is known about the relationship between perceived stress and attack severity, and about the role of perceived stress in the day-to-day experience of individuals with CM, as opposed to those with less frequent attacks.

Methods: This was an observational prospective longitudinal cohort study among adults with CM. Daily data about headache, symptoms, and lifestyle factors were collected using the N1-Headache™ digital health platform for 90 days. Days were classified as "migraine days" when a headache occurred that met the International Classification of Headache Disorders criteria. Perceived stress was measured using a 0-10 rating scale. On migraine days, peak pain severity was recorded on a four-point categorical pain scale. Participant-level plots of daily peak severity, colored by perceived stress score, were generated. The relationship between peak severity and perceived stress was also modeled and adjusted for sex, age, continuous headache, presence of menstrual bleeding, day of the week, and disability.

Results: Data on 136 participants with 8216 migraine days were analyzed. Sixty-nine percent (94/136) of participants reported the same peak severity on the majority (≥50%) of their migraine days. For every one unit increase in perceived stress, the odds of reporting a higher peak severity were 10% higher (adjusted OR [95% CI] = 1.10 [1.07-1.14]). The inclusion of random effects for the intercept and slope improved the model and demonstrated that there were large differences in individuals' reporting of peak severity and in the relationship between perceived stress and peak severity.

Conclusion: Individuals with CM report distinct patterns of peak severity from day-to-day. Although overall higher perceived stress was associated with higher peak severity, there is a substantial amount of variation between individuals in this relationship.

Keywords: chronic migraine; migraine; perceived stress; severity; stress.