Moderation And Mediation Of Headache-Related Disability: The Roles Of Self-Efficacy And Headache Diagnosis
Primary headache disorders such as migraine and tension-type headache are some of the most frequently-diagnosed health disorders in the world and can be extremely disabling. However, disability resulting from these disorders varies substantially across individuals. Although headache severity has been identified as the strongest predictor of headache-related disability, the relationship between the two variables is non-linear, suggesting that other mechanisms may be involved. Self-efficacy mediates relations between pain and impairment associated with other chronic pain conditions, but this relationship has not been evaluated in a sample of individuals with primary headache disorders. Therefore, the present study sought to examine whether headache self-efficacy acts as a mediator between headache severity and disability. The potential for moderated mediation by diagnostic status was also evaluated. The sample consisted of 822 college students with a mean age of 19.03 years (SD = 2.19), with 378 participants (46 %) meeting International Classification of Headache Disorders, 2nd Edition diagnostic criteria for ETTH, 363 (44.2%) for episodic migraine, and 81 (9.9%) for chronic migraine. Headache severity and disability were strongly associated, r (818) = .61, p < .01. Self-efficacy mediated the association between pain severity and disability for the sample as a whole (95% confidence interval [CI]: .12 to .33), although the clinical significance of this effect may be rather modest. Moreover, the mediation effect was moderated by headache diagnosis such that mediation was strongest for individuals suffering from episodic migraine (95% CI = .12 to .43). Overall, the results indicate that both pain severity and self-efficacy contribute to the extent to which an individual is disabled by their headaches. A strong belief in one's own ability to manage, function in spite of, and cope with pain may protect against disability resulting from headache pain. The present findings build upon and extend previous research that has focused primarily on individuals diagnosed with chronic and/or severe musculoskeletal pain and extend prior findings to the cyclical pain characteristic of migraine. There is a need for longitudinal studies, particularly among diverse populations, assessing the role that headache-management self-efficacy and other potential mediators play in the experience of headache.
Disability, Mediation, Migraine, Moderation, Self-Efficacy, Tension-Headache, Psychology
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