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Pain catastrophizing and disability in migraine: A cross-sectional analysis

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Created On: 19/11/2025

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Key take away

Pain catastrophizing is a key driver of migraine-related disability, pointing to the value of addressing psychological factors in management.

Background

Migraine is a widespread primary headache disorder that disrupts the quality of living. Research on the factors driving migraine-linked disability remains limited, specifically from a biopsychosocial perspective. Hence, this study examined whether transdiagnostic psychological factors, outlined in the Fear Avoidance Model (FAM), influence migraine-related disability independently of the severity of migraine symptoms.

Method

Recognizing that migraine disability extended beyond pain itself, this cross-sectional analysis drew on baseline data from an ongoing randomized controlled trial to investigate biopsychosocial contributors. A total of 158 migraine-affected people reporting ≥ 4 migraine days per month were assessed. Data were collected via an online survey that recorded sociodemographic and clinical information and included standardized assessments: the depression, anxiety, and stress scales (DASS), pain catastrophizing scale, fear of attacks in migraine inventory (FAMI), and headache impact test-6 (HIT-6).

Hierarchical multiple linear regression was performed in two sequential blocks:

Sociodemographic factors and migraine symptoms.
FAM factors — fear of attacks, pain catastrophizing, and depression.

Migraine-related disability was estimated via the HIT-6 questionnaire, and mediation analyses examined whether pain catastrophizing mediated the connection between pain degree or attack frequency and disability.

Result

In accordance with hierarchical regression, sociodemographic characteristics and migraine symptoms accounted for 49% of disability variance (R2adj = 0.49, p < 0.001). When FAM factors were included, the explained variance increased to 62% (R2adj = 0.62, ΔR²adj = 0.13, p < 0.001), demonstrating a strong model fit.

Key independent predictors were gender (ß = -0.15), age (ß = 0.11), maximum pain severity (ß = 0.46), pain catastrophizing (ß = 0.26), and depressiveness (ß = 0.13), all statistically significant. Mediation analysis showed 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 attack frequency did not act as a mediator (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

Transdiagnostic psychological factors exerted a substantial influence on migraine-related disability, beyond the effects of migraine symptoms and sociodemographic variables. Pain catastrophizing emerged as an important mediator linking pain intensity to disability, supporting the FAM and addressing the psychological processes in migraine care.