Perceived stress in patients with migraine: a case-control study

DOI: https://doi.org/10.1186/s10194- 017- 0780- 8

Abstract-Summary Perceived stress is the most common trigger for migraine.

The objective of this study was to examine the clinical significance of perceived

stress in migraine patients.

They completed self-reported questionnaires including Perceived Stress Scale (PSS), 12-item Allodynia Symptom Checklist (ASC-12), Migraine Disability Assessment Scale (MIDAS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Migraine-Specific Quality of Life Questionnaire (MSQ).

Degree of perceived stress in migraine patients was measured and compared to

that in healthy controls.

Predictors for perceived stress and their impact on quality of life (QOL) of

migraine patients were also determined.

Chronic migraine is a critical factor for perceived stress. Perceived stress affects QOL of migraine patients.

Background It has been found that migraine patients have higher levels of perceived stress than healthy controls [145, 146].

Stress can trigger migraine attacks. About 80% of migraine patients with identifiable triggers have reported that

stress is a common trigger [147].

In a Korean hospital-based study, stress is the most common trigger for episodic

migraine, followed by sleep deprivation and fatigue [148].

Factors associated with perceived stress in migraine patients have not been

reported yet.

If predictors for perceived stress of migraine patients can be identified, a guide-

line can be developed for clinicians to manage stress adequately.

The second aim of this study was to identify predictors for perceived stress in

migraine patients.

Although it is known that migraine and comorbid disorders will reduce QOL of

patients, the impact of stress on QOL has not been reported.

Methods It was measured by the 12-item Allodynia Symptom Checklist (ASC-12) with a cut- off score of >2 to define allodynic patients [149].

Eligible subjects underwent several self-reported questionnaires including the Korean version of Perceived Stress Scale (PSS) [150], Migraine Disability Assessment Scale (MIDAS) [151], Patient Health Questionnaire-9 (PHQ-9) [152], Generalized Anxiety Disorder-7 (GAD-7) [153], Epworth Sleepiness Scale (ESS) [154], Insomnia Severity Index (ISI) [155], and Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQ) [156].

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The degree of PSS score in migraine patients was examined and compared to that

in controls.

The Korean version of the PHQ-9 has been validated in patients with

migraine [152].

The Korean version of the GAD-7 has been validated in patients with

migraine [153].

Each ESS item score measures a particular “situational sleep propensity”. The sum of those item scores (i.e., total ESS score) measures the subject’s aver-

age sleep propensity across those different situations in daily life.

The Korean version of the ISI has been validated in patients with sleep disor-

ders [155].

Results Although migraine patients and controls had no significance difference in age, gen- der, employment status, household income, or body mass index, education level in migraine patients was significantly (p < 0.001) lower than that in controls.

A total of 208 (91.6%) migraine patients had migraine without aura while 103

(45.4%) patients had CM.

While the mean PSS score adjusted for education was significantly (p < 0.001) higher in migraine patients than that in controls, the score adjusted for education, depression, and anxiety in migraine patients was not significantly different from that in controls.

Regarding migraine chronicity, only CM patients had higher (p  <  0.05) mean

PSS scores than controls after controlling for education, depression, and anxiety.

CM, earlier onset of migraine, higher intensity of headache, phonophobia, allo- dynia, higher scores of MIDAS, PHQ-9, GAD-7, ESS, and ISI were associated with PSS score.

Discussion Our study revealed that the level of perceived stress was significantly higher in CM patients than that in controls.

While a higher level of perceived stress has been previously reported in migraine patients compared to that in healthy controls in two studies [145, 146], there was no difference in mean PSS score between migraine patients and controls after control- ling for depression and anxiety in this study.

This reveals that depression and anxiety are major determinants of perceived

stress in migraine patients and controls.

Depression and anxiety are not likely to be unique for perceived stress in patients

with migraine.

After investigating the relationship between migraine chronicity and perceived stress, it was found that CM patients had higher levels of perceived stress than controls.

Our data demonstrated that CM appeared to be a migraine-specific factor for

perceived stress.

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Personal and Societal Burden

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Conclusions It was found that the level of perceived stress was significantly higher in CM patients than that in controls.

Acknowledgement A machine generated summary based on the work of Moon, Hye-Jin; Seo, Jong- Geun; Park, Sung-Pa. 2017 in The Journal of Headache and Pain.

The burden attributable to headache disorders in children and adolescents in Lithuania: estimates from a national schools-based study