How are migraine-related stigma, psychological factors, and disability related? A cross-sectional investigation of associational patterns.

OBJECTIVE: To assess patterns of statistical associations among migraine stigma, psychological factors, and disability during the active migraine attack phase (the ictal disability burden) and in between attacks (the interictal disability burden). BACKGROUND: Previous work suggests perceived stigma toward migraine is an important contributor to migraine disability. Yet, it is currently unclear how migraine stigma is connected to disability and vice versa. Psychological distress factors (i.e., perceived stress, anxiety symptoms, depression symptoms, and pain catastrophizing) are putative variables that might contribute to associations between stigma and disability. METHODS: This was a web-based cross-sectional survey study of 103 American adults with active migraine conducted during 2024 to 2025. Relationships among perceived migraine-related stigma, perceived stress, anxiety and depression symptoms, pain catastrophizing, ictal disability, and interictal disability were assessed. Information was collected using a battery of questionnaires including the Migraine-Related Stigma questionnaire, MIDAS, Migraine Interictal Burden Scale-4, Pain Catastrophizing Scale (headache version), Generalized Anxiety Disorder-7 questionnaire, Patient Health Questionnaire-9, and Perceived Stress Scale-4. Associational variable analysis, an alternative framework for nonexperimental cross-sectional mediation studies, was used to examine associational patterns. RESULTS: Perceived stress was shown to partially account for variance between perceived migraine stigma and ictal disability (effect = 0.10, 95% confidence interval [CI] [0.01, 0.24]), whereas pain catastrophizing was found to partially account for the association between stigma and interictal disability (effect = 0.04, 95% CI [0.01, 0.09]). Transposing stigma and disability to examine reverse associations, perceived stress was found to partially account for the ictal disability-stigma association (effect = 0.03, 95% CI [0.0002, 0.07]), whereas depressive symptoms (effect = 0.25, 95% CI [0.04, 0.54]) and pain catastrophizing (effect = 0.44, 95% CI [0.11, 0.91]) were shown to partially account for associations between interictal disability and stigma. CONCLUSIONS: Among psychological variables examined, perceived stress and pain catastrophizing carried significant portions of stigma's relationship with ictal and interictal disability, respectively. Moreover, perceived stress (ictally) and depression symptoms/pain catastrophizing (interictally) accounted for portions of disability's relationship with stigma.