Psychological flexibility in migraine: A study of pain acceptance and values-based action

Cephalalgia. 2016 Apr;36(4):317-24. doi: 10.1177/0333102415590238. Epub 2015 Jun 10.


Background: Studies of musculoskeletal pain patients confirm that acceptance of pain and values-based action are strong predictors of pain-related disability and that interventions fostering "psychological flexibility" confer positive outcomes. However, data on these processes in migraine remain limited. This cross-sectional study examined relations between components of psychological flexibility and headache among treatment-seeking migraineurs.

Methods: A total of 103 adults (M age = 41.5 (11.9) years; 88.2% female) with ICHD-confirmed migraine (71.8% episodic, 28.2% chronic) across three clinics completed measures of psychological flexibility and headache-related disability. Hierarchical regressions quantified relations between acceptance/values-based action and headache variables after first controlling for pain severity and gender.

Results: Acceptance of pain and values-based action accounted for 10% of unique variance in headache severity (ΔR(2) p = 0.006) and up to 20% in headache-related disability (ΔR(2) ps = 0.02 and < 0.001) but were weakly related to headache frequency. Psychological flexibility was more strongly associated with MIDAS-measured disability than was headache severity or headache frequency. Significant effects were typically of medium-to-large size and driven primarily by values-based action.

Conclusions: Paralleling results from the broader chronic pain literature, pain acceptance and values-based action play significant roles in headache pain and disability. Further study of interventions targeting these processes may enhance existing treatments.

Keywords: Migraine; acceptance; acceptance and commitment therapy; disability; headache; psychological flexibility.

MeSH terms

  • Adaptation, Psychological*
  • Adult
  • Chronic Pain / psychology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Migraine Disorders / psychology*
  • Surveys and Questionnaires