The relationship between early maladaptive schemas and three dimensions of headache impact in Iranian outpatients with chronic migraine without aura

Authors

1 Behavioral Sciences Research Center, Baqiyatallah Medical University, Tehran, Iran

2 Spirituality and Medical research center, Baqiyatallah Medical University, Tehran, Iran

3 Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran

4 New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran

5 Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran

6 Baqiyatallah Medical University, Tehran, Iran

Abstract

Introduction: Although many researches showed that there are several psychiatric comorbidities in people suffering from migraine headache, few studies investigated the relationship between deep psychopathological structures and headache variables. The purpose of the present study was to elucidate the relationship between early maladaptive schemas and three dimensions of headache impact, pain intensity, disability and affective distress among Iranian outpatient females suffering from chronic migraine without aura.Methods: 136 consecutive outpatients suffering from a chronic migraine without aura were recruited from 553 consecutive outpatients complaining of a persistent headache and/or referred to a specialized headache clinic in Baqiyatallah Hospital. All participants completed two questionnaires regarding Schema Questionnaire–Short Form  McGill Pain Questionnaire–Short Form, Migraine Disability Assessment Scale, and the the State-Trait Anxiety Inventory-Trait subscale. Finally, Pearson product-moment correlation coefficients and multiple regression analyses were calculated to investigate relationships between the research variables.Results: The data analyses indicated that a significant amount of the variance of pain intensity was explained by self-sacrifice, emotional inhibition, and unrelenting standards/hypercriticalness. Also, self-sacrifice and unrelenting standards/hypercriticalness explained a significant amount of the variance of disability.  Further, a significant amount of variance of affective distress explained by emotional inhibition and unrelenting standards/hypercriticalness.Discussion: The findings emphasize on the predictive role of this early maladaptive schemas, especially early maladaptive schemas of the domain of overvigilance/inhibition.  Also, this study implicitly suggests that schema therapy can be an appropriate remedy for reducing headache impact dimensions, at least, in Iranian female outpatients suffering from migraine without aura.

Keywords


Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007; 68(5):343-349.
Morillo LE, Alarcon F, Aranaga N, Aulet S, Chapman E, Conterno L, Estevez E, Garcia-Pedroza F, Garrido J, Macias-Islas M, Monzillo P, Nunez L, Plascencia N, Rodriguez C, Takeuchi Y. Prevalence of migraine in Latin America. Headache. 2005; 45(2):106-117.
Stewart WF, Shechter A, Rasmussen BK. Migraine prevalence: A review of population-based studies. Neurology. 1994;44(6):17-23.
Ayatollahi SMT, Sahebi L, Haghighi AB. Epidemiologic and clinical characteristics of migraine and tension-type headaches among hospitals staffs of Shiraz (Iran). Acta Medica Iranica. 2009;47:115-120.
Shahrakai MR, Mirshekari H, Tajik-Ghanbari A, Shahraki AR, Shahraki E. Prevalence of migraine among medical students in Zahedan Faculty of Medicine (Southeast of Iran). Basic and Clinical Neuroscience. 2011;2(2):20-25.
Alam Z, Coombes N, Waring RH, Williams AC, Steventon GB. Plasma levels of neuroexcitatory amino acids in patients with migraine or tension headache. Journal of Neurological Sciences. 1998;156:102–106.
Goadsby PJ. Pathophysiology of migraine. Neurologic Clinics. 2009;27(2):335-360.
Gerber WD, Schoenen J. Biobehavioral correlates in migraine: the role of hypersensitivity and information-processing dysfunction. Cephalalgia. 1998;18(l):5-11.
Ligthart L, Gerrits M, Boomsma DI, Penninx BWJH. Anxiety and depression are associated with migraine and pain in general: An investigation of the Interrelationships. The Journal of Pain. 2013;14(4):363-370.
Stewart WF, Breslau N, Keck PE. Jr. Comorbidity of migraine and panic disorder. Neurology. 1994;44(7):23-27.
Savari K. The relationship of mental health, life satisfaction and perfectionism with migraine headaches. Knowledge and health. 2013;8(1):1-6.
Rezaei-Dogaheh E, Yoosefi A, Kami M. Comparison of maladaptive coping styles in patients with migraine and tension headaches with normal group. Practice in Clinical Psychology. 2014;2(3):235-243.
Abolghasemi A, Jafari E, Ahmadi-Tahoursoltani M. Comparison of perfectionism, aggression and coping styles in patients with migraine and tension-type headaches and healthy individuals. Journal of Kerman University of Medical Sciences. 2014;21(2):162-173.
Stewart WF, Lipton RB. The economic and social impact of migraine. European Neurology. 1994;34(2):12-17.
Velasco I, Gonzalez N, Etxeberria Y, Garcia-Monco J. Quality of life in migraine patients: A qualitative study. Cephalalgia. 2003;23(9):892–900.
Holroyd KA, Stensland M, Lipchik GL, Hill KR, O’Donnell FS, Cordingley G. Psychosocial Correlates and Impact of Chronic Tension-type Headaches. Headache. 2000;40:3-16.
Broadbenta E, Niederhofferb K, Haguec T, Cortera A, Reynoldsa L. Headache sufferers' drawings reflect distress, disability and illness perceptions. Journal of Psychosomatic Research. 2009;66:465-470.
Holroyd KA, Malinoski P, Davis MK, Lipchik, GL. The three dimensions of headache impact: pain, disability and affective distress. Pain. 1999;83:571-578.
Stovner Lj, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, Steiner T, Zwart JA. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193–210.
Curone M, Tullo V, Mea E, Proietti-Cecchini A, Peccarisi C, Bussone G. Psychopathological profile of patients with chronic migraine and medication overuse: Study and findings in 50 cases. Neurological Sciences. 2011;32(1):177–179.
Perozzo P, Savi L, Castelli L, Valfrè W, Giudice RL, Gentile S, Rainero I, Pinessi L. Anger and affective distress in patients with migraine and tension-type headache. Journal of Headache and Pain. 2005;6(5):392-399.
Torta R, Ieraci V. Migraine and depression comorbidity: Antidepressant options. Neurological Sciences. 2012;33(1):117–118.
Breslau N, Davis GC, Andreski P. Migraine, psychiatric disorders, and suicide attempts: An epidemiological study of young adults. Journal of Psychiatric Research. 1991;37:11-23.
Lipchic GL, Penzien DB. Psychiatric Comorbidities in Patients with Headaches. Seminars in Pain Medicine. 2004;2(2):93-105.
Merikangus KR, Angst JR, Isler H. Migraine and psychopathology: Results of the Zurich Cohort Study of young adults. Archives of General Psychiatry. 1990;47:849-853.
Mongini, F., Rota, E., Deregibus, A., Ferrero, L., Migliaretti, G., Cavallo, F., Mongini, T., & Novello, A. (2006). Accompanying symptoms and psychiatric comorbidity in migraine and tension-type headache patients. Journal of Psychosomatic Research. 61, 447–451.
Smitherman, T. A., Kolivas, E. D., & Bailey, J. R. (2013). Panic disorder and migraine: comorbidity, mechanisms, and clinical implications. Headache. 53(1), 23-45.
Levor RM, Cohen MJ, Naliboff BD, McArthur D. Psychosocial precursors and correlates of migraine headache. Journal of Consulting and Clinical Psychology. 1986;54(3):347-353.
Mongini F, Rota E, Evangelista A, Ciccone G, Milani C, Ugolini A, Ferrero L, Mongini T, Rosato R. Personality profiles and subjective perception of pain in head pain patients. Pain. 2009;144:125–129.
Pizza V, Spitaleri DLA, Colucci d’Amato C. The personality profile and alexithymic syndrome in primary headache: A Rorschach study. Journal of Headache and Pain. 2001;2(1):31–37.
Anda R, Tietjen G, Schulman E, Felitti V, Croft J. Adverse childhood experiences and frequent headaches in adults. Headache. 2010;50:1473-1481.
Davis DA, Luecken LJ, Zautra AJ. Are reports of childhood abuse related to the experience of chronic pain in adulthood? A meta-analytic review of the literature. Clinical Journal of Pain. 2005;21:398–405.
Domino JV, Haber JD. Prior physical and sexual abuse in women with chronic headache: Clinical correlates. Headache. 1987;27:310-314.
Felitti VJ. Long-term medical consequences of incest, rape, and molestation. Southern Medical Journal. 1991;84:328–331.
Glod CA. Long-term consequences of childhood physical and sexual abuse. Archives of Psychiatric Nursing. 1993;7:163–173.
Sansone R, Pole M, Dakroub H. Butler M. Childhood trauma, borderline personality symptomatology, and psychophysiological and pain disorders in adulthood. Psychosomatics. 2006;47:158–162.
Roberts SJ. The sequelae of childhood sexual abuse: a primary care focus for adult female survivors. Journal of Nurse Practitioners. 1996;45:49–52
Romans S, Belaise C, Martin J, Morris E, Raffi A. Childhood abuse and later medical disorders in women: an epidemiological study. Psychotherapy and Psychosomatics. 2002;71:141–150.
Guidetti V, Pagliarini M, Cortesi F, Formisano R, Cerbo R, Buzzi MG, D’Angelo M, Fioravanti A, Agnoli A. Mothers and children with primary headache: a psychometric and psychological study. Cephalalgia. 1985;5(3):162–164.
Maratos J, Wilkinson M. Migraine in children: a medical and psychiatric study. Cephalalgia. 1982;2:179-187.
Persson B. Growth environment and personality in adult migraineurs and their migraine-free siblings. Headache. 1997;37:159–168.
Santucci M, Mazzetti A, Maglietta EP, Santilli L, Stanzani P, Rossi PG. Psychological aspects of essential headache in childhood: a comparative study of migraine patients and patients suffering chronic headache. In: G Lanzi, U Balottin, A Cernibori, eds. Headache in children and adolescents. New York: Elsevier. 1989:277– 282.
Young JE, Klosko JS, Weishaar ME. Schema therapy: A practitioner’s guide. New York: The Guilford Press. 2003.
Young JE, Brown G. Young Schema Questionnaire. New York: Cognitive Therapy Center of New York. 1990.
Bayrami M, Bakhshipor A, Esmaeili A. The relationship between coping styles and early maladaptive schemas in disconnection-rejection and over vigilance-inhibition in young’s schema model. Journal of Life Science and Biomedicine. 2012;2(4):178-181.
Beck AT, Freeman A, et al. Cognitive therapy of personality disorders. New York: Guilford Press. 1990.
de Benedittis G, Lorenzetti A, Pieri A. The role of stressful life events in the onset of chronic primary headache. Pain. 1990;40:65–75.
Robbins L. Precipitating factors in migraine: a retrospective review of 494 patients. Headache. 1994;34:214–216.
Radat F, Lanteri-Mine M, Nachit-Ouinekh F, Massiou H, Lucas H, Pradalier A, Mercier F, Hasnaoui AEl. The GRIM2005 study of migraine consultation in France III: Psychological features of subjects with migraine. Cephalalgia. 2008;29:338–350.
Siniatchkin M, Riabus M, Riabus M. Coping styles of headache sufferers. Cephalagia. 1999;19:165-173.
Saariaho T, Saariaho A, Karila I, Joukamaa M. Early maladaptive schema factors, chronic pain and depressiveness: a study with 271 chronic pain patients and 331 control participants. Clinical Psychology and Psychotherapy. 2012 ;19(3):214–223.
Saariaho T, Saariaho A, Karila I, Joukamaa M.. Early maladaptive schema factors, pain intensity, depressiveness and pain disability: An analysis of biopsychosocial models of pain. Disability and Rehabilitation. 2012;34(14):1192-1201.
Saariaho T, Saariaho A, Karila I, Joukamaa M. Early maladaptive schemas in Finnish adult chronic male and female pain patients. Scandinavian Journal of Pain. 2010;1(4):196–202.
Cao M, Zhang S, Wang K, Wang Y, Wang W. Personality traits in migraine and tension-type Headaches: A five-factor model study. Psychopathology. 2002;35:54-258.
Schmidt NB, Joiner TE, Young JE, Telch M, J. The Schema Questionnaire: Investigation of psychometric properties and the hierarchical structure of a measure of maladaptive schemas. Cognitive Research and Therapy. 1995;19:295-321.
Sadooghi Z, Aguilar-Vafaie ME, Rasoulzadeh-Tabatabaie SK, Esfehanian N. Factor analysis of the young schema questionnaire-short form in a nonclinical Iranian sample. Iranian Journal of Psychiatry and Clinical Psychology. 2008;14(2):214-219.
Yousefi N, Etemadi A, Bahrami F, Ahmadi A, Fatehizade M. Comparing early maladaptive schemas among divorced and nondivorced couples as predictor of divorce. Iranian Journal of Psychiatry and Clinical Psychology. 2010;16(1):21-33.
Melzack R, Katz J. The McGill Pain Questionnaire: Appraisal and current status. In DC Turk, RJ Gatchel, eds. Psychological approaches to pain management: A practitioner’s handbook, 2nd ed. New York: Guilford. 2001: 35–52.
Mo’tamedi H, Rezaiemaram P, Tavallaie A. The effectiveness of a group-based acceptance and commitment additive therapy on rehabilitation of female outpatients with chronic headache: preliminary findings reducing 3 dimensions of headache impact. Headache. 2012;52:1106-1119.
Stewart WF, Lipton RB, Dowson AJ, Sawyer J. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology. 2001;56:20-28.
Spielberger CD, Gorsuch RL, Lushene R, Vagg RK, Jacobs, GA. State-Trait Anxiety Inventory for adults. Palo Alto, CA: Consulting Psychologists. 1983.
Hawke LD, Provencher MD, Arntz A. Early Maladaptive Schemas in the risk for bipolar spectrum disorders. Journal of Affective Disorders. 2011;133:428–436.
Passchier J, Goudswaard P, Orlebeke JF, Verhage F. Migraine and defense mechanisms: Psychophysiological relationships in young females. Social Science & Medicine. 1988;26(3):343-350.
Bottos S, Dewey D. Perfectionists’ appraisal of daily hassles and chronic headache. Headache. 2004;8:772–779.
Afshar H, Masaeli N, Shaigannezhad V, Asad-Elahi G. The examination of positive and negative scores of perfectionism among migraine patients and its comparison with control group. Armaghane-danesh Journal. 2007;12(14):9-16.
Bingham D, Hailey BJ. The time urgency component of the Type A behavior pattern: time pressure and performance. Journal of Applied Social Psychology. 1989;19:425-432.
Rappaport MB, McAnulty DP, Brantley PJ. Exploration of the type A behavior pattern in chronic headache sufferers. Journal of Consulting and clinical Psychology. 1988;56(4):621-623.
Cha NH, Lim S, Jung IT, Kim SY, An KA, Kim KS, Lee JD, Lee SH, Choi DY, Lee YH, Lee DI. A study on type A behavior pattern (TABP), stress, depression and HIT-6 in the patients with chronic headache. Journal of Korean Academy of Adult Nursing. 2005;17(4):539-547.
Linet MS, Celentano DD, Stewart WF. Headache characteristics associated with physician consultation: A population-based survey. American Journal of Preventive Medicine. 1991;7:40-46.
Marcus DA. Gender differences in treatment-seeking chronic headache sufferers. Headache. 2001;41(7):698–703.
Kelley K, Maxwell SE. Sample size for multiple regression: obtaining regression coefficients that are accurate, not simply significant. Psychological Methods. 2003;8(3):305–321.