Migraine, Personality, and Self-Management

Abstract

Migraine is a highly prevalent and disabling condition that significantly impacts sufferers, their families, and society. However, research and clinical understanding of migraine and its management remains poorly developed. Pathophysiological and environmental theories provide incomplete accounts of the development and maintenance of migraine. Therefore, researchers have turned to psychosocial factors that may contribute to the understanding of migraine, in particular through links to personality. Though an array of personality characteristics has intermittently been associated with migraine, the existence of a „migraine personality‟ remains uncertain. Furthermore, little is known regarding the ability of personality characteristics to predict not only migraine incidence but also greater dysfunction, in a dose-response type manner. Likewise, the self-management of migraine is under-researched. Although precipitants of migraine are widely studied, studies do not appear to assess whether these factors are addressed by migraineurs in their self-management strategies, how effectively they self-manage, nor factors associated with the effectiveness of self-management. The current study had four foci: (1) to identify the „migraine personality‟, (2) to investigate whether there are „dose-response‟ effects of personality on migraine, (3) to document individualised migraine self-management strategies, and (4) to evaluate the effectiveness of self-management as well as personality characteristics and illness perceptions that predict more or less effective selfmanagement. A cross-sectional case-control study of 52 migraine sufferers and 51 age-, sex-, and ethnicitymatched controls was conducted. All participants completed questionnaires about their demographics, general health, personality, and where appropriate, their migraine-related health and self-management strategies. Case-control analyses revealed that migraineurs were characterised by greater Type D negative affectivity, more frequent use of venting and planning coping styles, and lower monitoring – a personality profile indexing moderate levels of low mood and irritability along with a failure in inhibitory self-regulation. Type D negative affectivity also predicted greater migraine impact on life, providing preliminary support for a dose-response type effect of personality on migraine. Examination of self-management data allowed documentation of the idiographic self-management strategies used by migraineurs, which showed that commonly reported migraine precipitants were employed as strategies by migraineurs at different frequencies and were perceived to be differentially efficacious across the three stages of migraine selfmanagement (i.e. prevention, at the onset of, and during migraine). Moreover, the effectiveness of self-management varied across the preventive, onset, and during migraine stages of self-management. Personality characteristics and illness perceptions including emotional control and positive treatment beliefs were associated with more effective migraine self-management. In light of the serious impact of migraine on its sufferers, identifying the "migraine personality‟ may facilitate recognition of individuals who are at greater risk of this condition for early intervention. Greater understanding of the self-management strategies employed by migraineurs as well as the perceived efficacy of these strategies may allow healthcare providers to provide more tailored support for management.