When does empathy help? Patient-perceived physician empathy and migraine severity

Migraine is one of the most common neurological disorders and the second leading cause of disability worldwide. While it is known that psychosocial factors play an important role in illness, it is not clear how they are related to patients' perceptions of clinician empathy. We aimed to examine the relationship between the level of patient-perceived physician empathy and the frequency of migraine, migraine pain intensity, and migraine-related disability.

Two studies were conducted among patients diagnosed with migraine. Study 1 involved 70 participants with episodic and chronic migraine, while Study 2 involved 61 participants with episodic migraine. For four weeks, the subjects kept migraine diaries, assessing the occurrence of headaches, their intensity and the degree of migraine-related disability. In addition, the subjects completed the Migraine Disability Assessment (MIDAS) and the Consultation and Relational Empathy Measure (CARE).

The original hypothesis was not confirmed. Perceiving the physician as more empathetic was associated with retrospectively assessed greater migraine-related disability and greater retrospectively assessed migraine frequency, as well as greater migraine frequency assessed in the diary.

The results may suggest that migraine patients with more severe symptoms receive greater attention and support from physicians. These findings may reflect the situation of migraine patients in Poland, who are often treated dismissively by physicians unless they report very severe and serious symptoms. Interpretive hypotheses for further verification were also proposed, concerning secondary gains associated with illness and the exacerbation of symptoms through excessive attention directed toward them.

Our findings suggest that the way physicians communicate with patients may be associated with how patients experience migraine. Physicians may consider placing greater emphasis during consultations on patients' effective coping strategies and strengths, while placing less emphasis on difficulties and illness related limitations. However, this suggestion should be regarded as a hypothesis for future research rather than a clinical recommendation.