PAINMIG: Cohort Study for the Evaluation of Mental Pain in Migraine Patients

Background: The present study was aimed at evaluating psychosomatic, psychosocial, and psychological variables as potential risk and protective factors for migraine. Moreover, it aims to investigate psychosomatic, psychosocial, and psychiatric variables patients as potential risk and protective factors for mental pain in migraine subjects. Methods: A cohort study design was applied. Two-hundred subjects were enrolled at the Headache Center of the Careggi University Hospital (Florence, Italy): 100 subjects had a diagnosis of chronic migraine (CM) and 100 had a diagnosis of episodic migraine (EM). One-hundred healthy subjects (HS) were also enrolled form the general population of Central Italy as healthy controls (ratio case: control = 2:1). Participants completed a clinical assessment including: ID Migraine; Migraine Disability Assessment Questionnaire (MIDAS); Brief Pain Inventory (BPI); the Structured Clinical Interview for DSM-5 (SCID-5); Diagnostic Criteria for Psychosomatic Research-Revised Semi-Structured Interview (DCPR-R-SSI); Clinical Interview for Depression (CID); Psychosocial Index (PSI); Mental Pain Questionnaire (MPQ); Euthymia Scale (ES). Results: Among the variables taken into account higher levels of CID anxiety (OR = 1.39; 95% CI = 1.07–1.72; p = 0.012) and PSI psychological distress (OR = 1.24; 95% CI = 1.06–1.45; p = 0.007) were found as risk factors for EM as compared to HS, whereas PSI quality of life (OR = 0.50; 95% CI = 0.29–0.88; p = 0.016) was found as protective factor for EM as compared to HS. Mental pain (OR = 1.20; 95% CI = 1.01–1.50; p = 0.007) and PSI psychological distress (OR = 1.22; 95% CI = 1.07–1.36; p = 0.002) were found as t risk factors for CM as compared to HS, whereas ES well-being (OR = 0.70; 95% CI = 0.55–0.90; p = 0.006) was found as protective factor for CM as compared to HS. Higher mental pain (OR = 1.31; 95% CI = 1.08–1.59; p < 0.001) and PSI psychological distress (OR = 1.08; 95% CI = 1.00–1.16; p = 0.045) were found as risk factors for EM as compared to CM, whereas ES psychological well-being (OR = 0.73; 95% CI = 0.55–0.96; p = 0.027) was found as significant protective factor for EM as compared to CM. CID depression (OR = 1.06; 95% CI = 1.00–1.13; p = 0.046) and PSI psychological distress (OR = 1.20; 95% CI = 1.01–1.50; p = 0.007) were found risk factors for having mental pain in migraine subjects, whereas ES psychological well-being (OR = 0.69; 95% CI = 0.53–0.95; p = 0.007) and PSI psychosocial well-being (OR = 0.44; 95% CI = 0.31–0.70; p = 0.001) were found as protective factors for having mental pain in migraine subjects. Conclusion: The assessment of migraine subjects which aims at being comprehensive according to psychosomatic principles should include the Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R), the Mental Pain Questionnaire (MPQ), and the Euthymia Scale (ES). Mental pain is a psychosomatic variable deserving attention in chronic migraine patients. ES Well-being is a protective factor for both chronic migraine and mental pain.