Comparison of Pain-Related and Psychological Variables between Acute and Chronic Migraine Patients, and Factors Affecting Headache Chronicity

Document Type: Original Article


1 Shiraz University of Medical Sciences, Shiraz, Iran

2 Community Based Psychiatric Care Research Center, Department of Mental Health Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Migraine headache is classified as acute or chronic. In recent years, efforts have been
made to identify the factors that might predispose individuals to develop the chronic-type headache.
The present study aimed to draw a comparison between patients with acute and chronic migraine in
terms of demographic, pain-related, and psychological variables. In addition, we also investigated
factors affecting headache chronicity in such patients.
Methods: The present cross-sectional study was conducted during 2017-2018. The target sample
consisted of 250 patients with acute or chronic migraine who referred to various clinics affiliated
to Shiraz University of Medical Sciences (SUMS), Shiraz, Iran, recruited by convenience sampling.
All the participants filled in the questionnaires related to demographic characteristics, pain intensity,
disability, depression, emotional intelligence, and anger. The data were analyzed using SPSS software
(version 22.0) with t test, Chi-square test, and logistic regression analysis. Pstatistically significant.
Results: Patients suffering from chronic migraine experienced higher levels of disability, depression,
anger, and had lower levels of emotional intelligence compared to those with acute migraine. Based
on the logistic regression analysis, variables that had a significant effect on headache chronicity were
female gender (OR=5.81), married status (OR=3.77), patients with lower level of education (OR=0.26),
headache duration (OR=1.53), disability (OR=0.28), depression (OR=3.66), and anger (OR=5.04).
Conclusion: Variables such as disability, depression, and lack of anger control were among the key
factors associated with headache chronicity in migraine patients.



  1. Williams AC, Craig KD. Updating the definition of pain. Pain. 2016;157:2420-3.
  2. Cano A, Miller LR, Loree A. Spouse beliefs about partner chronic pain. The Journal of Pain. 2009;10:486-92.
  3. Wahl AK, Rustøen T, Rokne B, et al. The complexity of the relationship between chronic pain and quality of life: a study of the general Norwegian population. Quality of Life Research. 2009;18:971-80.
  4. Racine M. Chronic pain and suicide risk: A comprehensive review. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2018;87:269-80.
  5. Shaygan M. Intensity of depression, its predictive and mediating factors in the patients with chronic headache. Scientific Journal of Kurdistan University of Medical Sciences. 2017;22:110-9.
  6. Fasick V, Spengler RN, Samankan S, et al. The hippocampus and TNF: Common links between chronic pain and depression. Neuroscience and Biobehavioral Reviews. 2015;53:139-59.
  7. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629-808.
  8. May A, Schulte LH. Chronic migraine: risk factors, mechanisms and treatment. Nature Reviews Neurology. 2016;12:455-64.
  9. Katsarava Z, Buse DC, Manack AN, Lipton RB. Defining the differences between episodic migraine and chronic migraine. Current Pain and Headache Reports. 2012;16:86-92.
  10. Young*Casey C, Greenberg MA, Nicassio PM, et al. Transition from acute to chronic pain and disability: a model including cognitive, affective, and trauma factors. Pain. 2008;134:69-79.
  11. Lantéri-Minet M, Duru G, Mudge M, Cottrell S. Quality of life impairment, disability and economic burden associated with chronic daily headache, focusing on chronic migraine with or without medication overuse: a systematic review. Cephalalgia. 2011;31:837-50.
  12. Buse DC, Manack AN, Fanning KM, et al. Chronic migraine prevalence, disability, and sociodemographic factors: results from the American Migraine Prevalence and Prevention Study. Headache. 2012;52:1456-70.
  13. Davey C, Lopez-Sola C, Bui M, et al. The effects of stress–tension on depression and anxiety symptoms: evidence from a novel twin modelling analysis. Psychological Medicine. 2016;46:3213-8.
  14. Baskin SM, Smitherman TA. Comorbidity between migraine and depression: update on traditional and alternative treatments. Neurological Sciences. 2011;32:S9-13.
  15. Carod-Artal FJ, Irimia P, Ezpeleta D. Chronic migraine: definition, epidemiology, risk factors and treatment. Revista de Neurologia. 2012;54:629-37. [In Spanish]
  16. Kim SY, Park SP. The role of headache chronicity among predictors contributing to quality of life in patients with migraine: a hospital-based study. The Journal of Headache and Pain. 2014;15:68.
  17. Lipton RB. Tracing transformation: chronic migraine classification, progression, and epidemiology. Neurology. 2009;72:S3-7.
  18. Katsarava Z, Schneeweiss S, Kurth T, et al. Incidence and predictors for chronicity of headache in patients with episodic migraine. Neurology. 2004;62:788-90.
  19. Rossi P, Di*Lorenzo G, Malpezzi MG, et al. Depressive symptoms and insecure attachment as predictors of disability in a clinical population of patients with episodic and chronic migraine. Headache. 2005;45:561-70.
  20. Paice JA, Cohen FL. Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nursing. 1997;20:88-93.
  21. Imani F. A Comprehensive Book of Pain. Anesthesiology and Pain. 2013;3:133-4. [In Persian]
  22. Vakilzadeh P, Nakhaei N. validity and reliability of a short questionnaire of pain in patients with cancer. Journal of Rafsanjan University of Medical Sciences. 2007;5:253-8. [In Persian]
  23. Stewart WF, Lipton RB, Whyte J, et al. An international study to assess reliability of the Migraine Disability Assessment (MIDAS) score. Neurology. 1999;53:988-94.
  24. ErtaƟ M, Siva A, Dalkara T, et al. Validity and reliability of the Turkish Migraine Disability Assessment (MIDAS) questionnaire. Headache. 2004;44:786-93.
  25. Zandifar A, Asgari F, Haghdoost F, et al. Reliability and validity of the migraine disability assessment scale among migraine and tension type headache in Iranian patients. BioMed Research International. 2014;2014:978064.
  26. Martin A, Rief W, Klaiberg A, Braehler E. Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. General Hospital Psychiatry. 2006;28:71-7.
  27. Lotrakul M, Sumrithe S, Saipanish R. Reliability and validity of the Thai version of the PHQ-9. BMC Psychiatry. 2008;8:46.
  28. Khamseh ME, Baradaran HR, Javanbakht A, et al. Comparison of the CES-D and PHQ-9 depression scales in people with type 2 diabetes in Tehran, Iran. BMC Psychiatry. 2011;11:61.
  29. Bradbury T, Greaves J. The emotional intelligence quick book: Everything you need to know to put your EQ to work. New York: Simon & Schuster; 2005.
  30. Stys Y, Brown SL. A review of the emotional intelligence literature and implications for corrections. Canada: Research Branch Correctional Service of Canada; 2004.
  31. Ganji H, Mirhashemi M, Sabet M. Bradberry-Greaves’ Emotional Intelligence Test: Preliminary Norming-Process. Journal of Thought and Behavior. 2007;1:23-35. [In Persian]
  32. Novaco RW. The Novaco anger scale and provocation inventory: NAS-PI. Los Angeles: Western Psychological Services; 2003.
  33. Malakpour M, Zanganeh S, Aghababaei S. A study of the psychometric properties of Novaco Anger Questionnaire (short form) in Isfahan City. Journal of Researches of Cognitive and Behavioral Sciences. 2012;2:1-8. [In Persian]
  34. Schramm SH, Obermann M, Katsarava Z, et al. Epidemiological profiles of patients with chronic migraine and chronic tension-type headache. The Journal of Headache and Pain. 2013;14:40.
  35. Zebenholzer K, Andree C, Lechner A, et al. Prevalence, management and burden of episodic and chronic headaches-a cross-sectional multicentre study in eight Austrian headache centres. The Journal of Headache and Pain. 2015;16:46.
  36. Blumenfeld AM, Varon SF, Wilcox TK, et al. Disability, HRQoL and resource use among chronic and episodic migraineurs: results from the International Burden of Migraine Study (IBMS). Cephalalgia. 2011;31:301-15.
  37. Rist PM, Schürks M, Buring JE, Kurth T. Migraine, headache, and the risk of depression: Prospective cohort study. Cephalalgia. 2013;33:1017-25.
  38. Nespereira-Campuzano T, Vázquez-Campo M. Emotional intelligence and stress management in Nursing professionals in a hospital emergency department. Enfermería Clínica. 2017;27:172-8.
  39. Buscemi V, Chang WJ, Liston MB, et al. The role of psychosocial stress in the development of chronic musculoskeletal pain disorders: protocol for a systematic review and meta-analysis. Systematic Reviews. 2017;6:224.
  40. Liossi C, White P, Schoth DE. Time-course of attentional bias for threat-related cues in patients with chronic daily headache–tension type: evidence for the role of anger. European Journal of Pain. 2011;15:92-8.