Targeting individual pain catastrophizing to reduce migraine-related disability: a randomized controlled proof-of-concept trial using an online CBT intervention.

This mechanistic randomized controlled proof-of-concept trial (RCT) investigated whether a brief online Cognitive Behavioral Therapy (CBT)-based avatar intervention can reduce individual pain catastrophizing in individuals with migraine and examined whether reductions in individual pain catastrophizing are associated with decreased migraine-related disability. Migraine is a highly disabling disorder, yet the mechanisms underlying migraine-related disability remain poorly understood. The Fear Avoidance Model (FAM) and recent research suggest that pain catastrophizing is a key mediator linking migraine experience with disability. A total of N = 55 individuals with migraine and ≥ 4 migraine days/month were randomized to either an intervention group (receiving cognitive restructuring targeting individual pain catastrophizing statements), or an active control group (contradicting false statements about migraine). Assessments at baseline, post-intervention, and six-week follow-up included individual Pain Catastrophizing (PCS-3), Headache Impact Test (HIT-6), as well as migraine-related and clinical characteristics. Intervention was evaluated using linear mixed-effects model. Hierarchical regression was used to determine the predictive effect of reductions in pain catastrophizing on reductions in disability. The intervention group demonstrated significantly greater reductions in pain catastrophizing at post-intervention (p = 0.009), while group differences diminished by follow-up. Decreases in individual pain catastrophizing were associated with reductions in migraine-related disability in both groups, explaining 24% of the variance (R2adj = 0.24; p = 0.004). These findings suggest pain catastrophizing as a relevant factor in cognitive-affective pain processing contributing to migraine-related disability, as proposed by the FAM. It represents a potential therapeutic target that can be addressed through CBT-based interventions.