The Migraine Disability Assessment (MIDAS) as an Indicator of Resilience in Patients with Headaches

BACKGROUND: The Migraine Disability Assessment is a clinical tool to measure disability in migraine patients. However, Migraine Disability Assessment predicted disability does not always correlate with actual functional disability, with some high-scoring patients remaining high functioning, and some low-scoring patients having poor functional outcomes. Based on these observed discrepancies, we investigated whether the Migraine Disability Assessment was also an indicator of resilience. Our objectives were to correlate the degree of headache disability with measures of resilience, as quantified by the Conner Davidson Resilience Scale; determine whether the level of resilience modified the association between headache severity/frequency and disability; and assess the association between anxiety and depression with resilience in headache patients. METHODS: We prospectively recruited patients with primary headache disorders seen in an academic, tertiary Headache Medicine program between 02/20/2018 and 08/02/2019 to participate in this study. Each participant completed 5 validated measures in the clinic: Migraine Disability Assessment, Conner Davidson Resilience Scale, Patient Health Questionnaire-9, General Anxiety Disorder-7 and WHO Well-Being Index. RESULTS: Complete data were obtained and analyzed for 160 participants. Consistent with our hypothesis, the Conner Davidson Resilience Scale score was negatively correlated with total Migraine Disability Assessment score (r= -.0.21, p=0.0091), total General Anxiety Disorder-7 score (r= -0.56, p<.0001) and total Patient Health Questionnaire-9 score (r=-0.34, p<.0001). In participants with severe headache-related disability (Migraine Disability Assessment > 21), logistical regression models showed negative associations between resilience and headache-related disability, anxiety and depression. A one point increase in the Conner Davidson Resilience Scale score decreased the odds of being severely disabled by 4% (OR = 0.96, p=0.001). After adjusting for resilience score and age, only the total General Anxiety Disorder-7 score was associated with severe disability, with a one-point increase in total General Anxiety Disorder-7 score increasing the odds of severe disability by 16% (OR=1.16, p<.001). Similarly, a one point increase in total Patient Health Questionnaire-9 score, increased the odds of being severely disabled by 24% (OR=1.24, p<.001). CONCLUSION: A higher resilience score inversely correlated with headache-related disability in this cohort. In participants with severe disability as measured by Migraine Disability Assessment, higher levels of anxiety and depression were associated with increased levels of headache-related disability.