The cortisol awakening response in women with episodic migraine receiving acceptance and commitment therapy

The cortisol awakening response (CAR) is a core biomarker of hypothalamic-pituitary-adrenal (HPA) axis regulation. Nevertheless, studies of HPA-axis function among migraine patients are scarce and equivocal. This study's objective was to investigate the association between CAR and psychosocial outcomes in migraine patients receiving Acceptance and Commitment Therapy (ACT).

Episodic migraine patients (N = 32) randomized to receive 8 group ACT sessions completed self-report questionnaires assessing headache-related disability, depression and anxiety, pain catastrophizing, distress tolerance and perceived stress, before and after the intervention. Salivary cortisol samples were also collected at 3 timepoints (awakening (cortisol), 15-, and 45-min post-awakening) pre-post intervention and the CAR was calculated. Pre-post differences of all cortisol measures and correlations between them and all assessed clinical outcomes, were calculated. Multiple linear regression was used to assess the relationships between these factors.

Pre-post awakening cortisol values were within normal range. The CAR and awakening cortisol did not change significantly pre-post. At baseline, the awakening cortisol was positively correlated with headache-related disability and the CAR was negatively correlated with depression. Results from multiple linear regression indicated that baseline CAR showed a trend-level association with migraine-related disability after controlling for baseline pain catastrophizing and depression.

The analysis of salivary samples from women with episodic migraines before and after ACT indicates that the CAR may hold a promise as a related to treatment response in migraine-related disability. Future research with larger and more diverse groups is needed to confirm and extend these preliminary findings.