Exploring the relationship between pain catastrophizing and migraine in youth: A longitudinal clinical cohort study

This study explored the relationship between pain catastrophizing and migraine-related outcomes (i.e., migraine-related disability and headache frequency) between visits with a neurologist in a clinical population of children and adolescents with migraine.

Evidence from adult populations suggests that pain catastrophizing, the tendency to magnify the threat value of, and ruminate and feel helpless about, pain may be associated with migraine-related outcomes, but the association in children and adolescents is less clear.

In this prospective longitudinal clinical cohort study, children and adolescents aged 8-18 years with migraine completed headache questionnaires and a validated measure of pain catastrophizing (Pain Catastrophizing Scale for Children) at baseline and initial follow-up visits with a neurologist. Recruitment spanned from May 2019 to July 2023. Headache frequency and migraine-related disability (Pediatric Migraine Disability Assessment) were assessed at both visits. Migraine outcomes at follow-up were examined in relation to baseline pain catastrophizing scores in models that controlled for sex, age, preventive treatment use, baseline headache frequency, and baseline disability.

For this study, 121 consenting participants were included. In models adjusted for age, sex, baseline headache frequency, baseline disability, and preventive treatment use, baseline pain catastrophizing scores were significantly associated with disability scores at follow-up (β = 0.81, 95% confidence interval [CI] = 0.13-1.48, p = 0.020), but not with headache frequency at follow-up (β = 0.04, 95% CI = -0.10 to 0.19, p = 0.575). When examining the specific subscales of pain catastrophizing in an adjusted model, only baseline pain magnification (β = 6.73, 95% CI = 2.95-10.51, p = 0.001) had a significant association with disability at follow-up, while feelings of helplessness (β = 0.08, 95% CI = -2.11 to 2.27, p = 0.944) and rumination did not (β = -1.83, 95% CI = -4.22 to 0.56, p = 0.133). In a subset of participants with pain catastrophizing measured at both visits (n = 65), pain catastrophizing total and subscale scores did not significantly differ between visits.

Baseline pain catastrophizing scores were associated with migraine-related disability, but not headache frequency, at follow-up in a clinical population of children and adolescents with migraine. Pain magnification specifically appeared to drive this association. Future studies should aim to replicate our results and to investigate if interventions aimed specifically at reducing pain magnification may help to mitigate migraine-related disability in children and adolescents.