Headache Medicine 2020, 11(2):39-43 ISSN 2178-7468, e-ISSN 2763-6178

ASAA

DOI: 10.48208/HeadacheMed.2020.12

Headache Medicine

Original

Main symptoms associated with the catastrophizing in women with

bromyalgia and migraine

Amanda de Oliveira Freire Barros

Manuella Moraes Monteiro Barbosa Barros

Reydiane Rodrigues

Santana

Débora Wanderley

Angélica da Silva Tenório

Daniella Araújo de Oliveira

Physical Therapy Department, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.

Post-graduation Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.

Abstract

Objective

To evaluate the main symptoms associated with catastrophizing in women with bromyalgia

and migraine.

Methods

We conducted an observational study with 26 women diagnosed with both bromyalgia

and migraine, aged between 30 and 60 yrs (46±8 yrs). The Pain Catastrophizing Scale was

applied as a cut-off point of 30, dividing the volunteers into groups with (n=18) and without

catastrophizing (n=8). We assessed the quality of sleep (Pittsburgh Sleep Quality Index), the

presence of depression and anxiety (Beck's Depression and Anxiety Inventories), the quality

of life perception (Fibromyalgia Impact Questionnaire-revised), the disability due to migraine

(Migraine Disability Assessment), and the level of physical activity (International Physical

Activity Questionnaire).

Results

The time of bromyalgia did not differ (p=0.80) between the group with (8.54±4.88 yrs) and

without catastrophizing (10.04±3.47 yrs). The Fibromyalgia Impact Questionnaire-revised

scores were signicantly higher (p=0.01) among women with catastrophizing (78.0±12.6)

than those without (56.6±22.3). There was no difference between the groups (p>0.05) in

relation to the other outcomes evaluated.

Conclusion

The presence of catastrophizing in women with bromyalgia and migraine are associated

with a worse perception of quality of life.

Manuella Moraes Monteiro Barbosa

Barros

Departamento de Fisioterapia, Laboratório

de Aprendizagem e Controle Motor, Uni-

versidade Federal de Pernambuco.

Av. Jornalista Aníbal Fernandes, 173 - Ci-

dade Universitária, Recife – Pernambuco.

Phone number: +55 81 2126-8492; +55

81 2126-8937.

manu_mmbb@hotmail.com

Received: May 27, 2020.

Accepted: June 5, 2020.

Edited by

Marcelo Moraes Valença

Keywords:

Fibromyalgia

Migraine disorders

Catastrophization

Sleep

Depression

Anxiety Disorders

Quality of life

Disability

Exercise

ASAA

Freire Barros AOF, Barbosa Barros MMMB, Santana RR, Wanderley D, Tenório AS, Oliveira DA

Main symptoms associated to the catastrophizing in women with fibromyalgia and migraine

Introduction

ibromyalgia is a a broad-spectrum disease that has an average

worldwide prevalence of 4.1% in women.

Over the years, the

classication of bromyalgia by the American College of Rheuma-

tology has undergone improvements, ceasing to be characterized

only by chronic widespread pain and the presence of tender points

in anatomically specic regions, known as tender points.

Currently

the classication takes into account the symptoms associated with

this disease.

3,4

The etiology of bromyalgia is not yet fully understood, but several The etiology of bromyalgia is not yet fully understood, but several

factors contribute to its development, including dysfunctions of the factors contribute to its development, including dysfunctions of the

central and autonomic nervous system, neuroendocrine disorders, central and autonomic nervous system, neuroendocrine disorders,

regulation of neurotransmitters, changes in the hypothalamic-pitui-regulation of neurotransmitters, changes in the hypothalamic-pitui-

tary axis, and exposure to stressors.tary axis, and exposure to stressors.

5,65,6

Sensory stimuli transmitted Sensory stimuli transmitted

to the central nervous system are processed in an altered manner, to the central nervous system are processed in an altered manner,

resulting in generalized pain and changes in the painful threshold.resulting in generalized pain and changes in the painful threshold.

6,76,7

Fibromyalgia presents a complex picture that includes numerous Fibromyalgia presents a complex picture that includes numerous

symptoms such as depression, anxiety, headache, cognitive, and symptoms such as depression, anxiety, headache, cognitive, and

sleep disorders and negative impacts on quality of life.sleep disorders and negative impacts on quality of life.

In this In this

context, migraine is a relevant symptom and represents the type of context, migraine is a relevant symptom and represents the type of

headache most found in patients with bromyalgia, whose preva-headache most found in patients with bromyalgia, whose preva-

lence varies between 45% and 80%.lence varies between 45% and 80%.

In addition, the cognitive and emotional aspects related to the pain In addition, the cognitive and emotional aspects related to the pain

experienced by bromyalgia patients involve a catastrophizing experienced by bromyalgia patients involve a catastrophizing

thought, recognized as a negative state in the face of a painful thought, recognized as a negative state in the face of a painful

experience.experience.

1010

Depression is part of the factors that interfere with the Depression is part of the factors that interfere with the

painful perception of bromyalgia, but unlike catastrophization, it painful perception of bromyalgia, but unlike catastrophization, it

refers to sadness, discouragement, lack of interest, and unwilling-refers to sadness, discouragement, lack of interest, and unwilling-

ness to perform activities that previously gave you pleasure. In ness to perform activities that previously gave you pleasure. In

turn, catastrophizing is specically related to thoughts and feelings turn, catastrophizing is specically related to thoughts and feelings

linked to the painful situation, such as fear, worry, inability to divert linked to the painful situation, such as fear, worry, inability to divert

attention, and deal with pain.attention, and deal with pain.

1111

There is still a lack of studies in the literatureThere is still a lack of studies in the literature

12–1512–15

evaluating the pre- evaluating the pre-

sence of catastrophization however, it is known that this symptom sence of catastrophization however, it is known that this symptom

is related to chronic pain, feelings of incapacity,is related to chronic pain, feelings of incapacity,

1212

more severe de- more severe de-

grees of depression and anxiety, more migraine attacks,grees of depression and anxiety, more migraine attacks,

1313

exercise exercise

intoleranceintolerance

1414

and sleep disorders and sleep disorders

1515

. Also, catastrophization can . Also, catastrophization can

worsen the perception of these symptoms, which are also present worsen the perception of these symptoms, which are also present

in bromyalgia and migraine, making it necessary to evaluate them in bromyalgia and migraine, making it necessary to evaluate them

to guide the treatment of patients.to guide the treatment of patients.

Despite the above, the catastrophization of pain has not yet been Despite the above, the catastrophization of pain has not yet been

analyzed in women with associated bromyalgia and migraine. analyzed in women with associated bromyalgia and migraine.

Thus, the present study aimed to assess the main symptoms as-Thus, the present study aimed to assess the main symptoms as-

sociated with catastrophization in women with bromyalgia and sociated with catastrophization in women with bromyalgia and

migraine.migraine.

Methods

This is an observational, cross-sectional study. The research was This is an observational, cross-sectional study. The research was

carried out from March to November 2015, at the school clinic of the carried out from March to November 2015, at the school clinic of the

Physiotherapy Department of the Federal University of Pernambuco Physiotherapy Department of the Federal University of Pernambuco

(UFPE), Recife, Pernambuco, Brazil. The research was approved by (UFPE), Recife, Pernambuco, Brazil. The research was approved by

the Human Research Ethics Committee of the Health Sciences Center the Human Research Ethics Committee of the Health Sciences Center

of UFPE (CAAE 37052114.3.0000.5208). All participants signed of UFPE (CAAE 37052114.3.0000.5208). All participants signed

an informed consent form. an informed consent form.

Sample

The participants were recruited from the list of patients seen at the The participants were recruited from the list of patients seen at the

bromyalgia outpatient clinic of the rheumatology sector at Hospital bromyalgia outpatient clinic of the rheumatology sector at Hospital

das Clínicas, UFPE. Patients who met the following inclusion criteria das Clínicas, UFPE. Patients who met the following inclusion criteria

were selected: 1. having a diagnosis of bromyalgia and migraine, were selected: 1. having a diagnosis of bromyalgia and migraine,

simultaneously; and 2. age between 30 and 60 years. Pregnant wo-simultaneously; and 2. age between 30 and 60 years. Pregnant wo-

men were excluded due to hormonal changes and their relationship men were excluded due to hormonal changes and their relationship

with the presence of migraine, and obese participants.with the presence of migraine, and obese participants.

Procedures for data collection

By phone, the participants were invited to participate in the survey By phone, the participants were invited to participate in the survey

and asked about the eligibility criteria. In the initial evaluation, a and asked about the eligibility criteria. In the initial evaluation, a

semi-structured questionnaire was applied to obtain sociodemogra-semi-structured questionnaire was applied to obtain sociodemogra-

phic and clinical data. Then, they went through the evaluation of phic and clinical data. Then, they went through the evaluation of

a neurologist who diagnosed the type of headache, based on the a neurologist who diagnosed the type of headache, based on the

criteria of the International Classication of Headache Disorders, criteria of the International Classication of Headache Disorders,

rdrd

edition - beta version. edition - beta version.

1616

The presence of catastrophizing was assessed using the pain catas-The presence of catastrophizing was assessed using the pain catas-

trophizing scale. This instrument, validated and adapted to Portugue-trophizing scale. This instrument, validated and adapted to Portugue-

se (Cronbach alpha= 0.91), assesses the thoughts and feelings of the se (Cronbach alpha= 0.91), assesses the thoughts and feelings of the

volunteers in the face of pain experience and consists of 13 items, volunteers in the face of pain experience and consists of 13 items,

whose score ranges from 0-4, with 52 being the maximum score.whose score ranges from 0-4, with 52 being the maximum score.

1717

The global score of 30 indicates that the individual has clinically The global score of 30 indicates that the individual has clinically

relevant levels of catastrophization.relevant levels of catastrophization.

1818

The sample was then divided The sample was then divided

into two groups, one with catastrophization and one without.into two groups, one with catastrophization and one without.

Outcome Assessment

The sleep quality outcome was assessed using the Pittsburgh Sleep The sleep quality outcome was assessed using the Pittsburgh Sleep

Quality Index (PSQI), validated and adapted for the Brazilian po-Quality Index (PSQI), validated and adapted for the Brazilian po-

pulation, with high reliability (Cronbach α= 0.82). The PSQI has 19 pulation, with high reliability (Cronbach α= 0.82). The PSQI has 19

questions ranging from 0-3 and is divided into seven components questions ranging from 0-3 and is divided into seven components

related to sleep: subjective quality, latency, duration, habitual ef-related to sleep: subjective quality, latency, duration, habitual ef-

ciency, changes and the use of sleep medications, and daytime ciency, changes and the use of sleep medications, and daytime

dysfunction. The total score was given by the sum of all components, dysfunction. The total score was given by the sum of all components,

reaching a maximum of 21 points.reaching a maximum of 21 points.

1919

The depression outcome was assessed by Beck Depression Inventory The depression outcome was assessed by Beck Depression Inventory

(BDI), an instrument consisting of 21 multiple-choice questions ran-(BDI), an instrument consisting of 21 multiple-choice questions ran-

ging from 0-3 points, reaching a maximum total score of 63. From ging from 0-3 points, reaching a maximum total score of 63. From

the score obtained, the participants were classied as absence (0-9 the score obtained, the participants were classied as absence (0-9

ASAA

Freire Barros AOF, Barbosa Barros MMMB, Santana RR, Wanderley D, Tenório AS, Oliveira DA

Main symptoms associated to the catastrophizing in women with fibromyalgia and migraine

points), mild depression (10-18 points), moderate (19-29 points), and points), mild depression (10-18 points), moderate (19-29 points), and

severe (>30 points). BDI is validated and adapted for the Brazilian severe (>30 points). BDI is validated and adapted for the Brazilian

population (Cronbach α= 0.81).population (Cronbach α= 0.81).

20,2120,21

Anxiety was assessed by the Anxiety was assessed by the

Beck Anxiety Inventory (BAI), which is also validated and adapted for Beck Anxiety Inventory (BAI), which is also validated and adapted for

the Brazilian population. Composed of 23 multiple-choice questions the Brazilian population. Composed of 23 multiple-choice questions

(ranges from 0-4), the total score was achieved by the sum of all (ranges from 0-4), the total score was achieved by the sum of all

items, reaching a maximum of 63 points, generating the classication: items, reaching a maximum of 63 points, generating the classication:

minimal anxiety (0-10 points), mild (11-19 points), moderate (20-30 minimal anxiety (0-10 points), mild (11-19 points), moderate (20-30

points) and severe (> 31 points).points) and severe (> 31 points).

2222

The impact of bromyalgia on the quality of life of the volunteers The impact of bromyalgia on the quality of life of the volunteers

was measured by Fibromyalgia Impact Questionnaire-Revised (FI-was measured by Fibromyalgia Impact Questionnaire-Revised (FI-

Q-R), with validation and adaptation for the Brazilian population Q-R), with validation and adaptation for the Brazilian population

(Cronbach's alpha of 0.96). The instrument contains 21 questions (Cronbach's alpha of 0.96). The instrument contains 21 questions

that can vary from 0-10, with 100 being the maximum score. The that can vary from 0-10, with 100 being the maximum score. The

FIQ-R is divided into three domains: function, global impact, and FIQ-R is divided into three domains: function, global impact, and

symptom intensity. The nal score was given by the sum of these and symptom intensity. The nal score was given by the sum of these and

the higher, the greater the impact of bromyalgia on quality of life. the higher, the greater the impact of bromyalgia on quality of life.

The level of pain resulting from bromyalgia was assessed using this The level of pain resulting from bromyalgia was assessed using this

questionnaire, which presents a specic scale related to pain, whose questionnaire, which presents a specic scale related to pain, whose

domain of symptom intensity varies from zero to ten.domain of symptom intensity varies from zero to ten.

2323

Migraine disability was assessed by the Migraine Disability As-Migraine disability was assessed by the Migraine Disability As-

sessment Test (MIDAS). From the sum of the scores, the volunteers sessment Test (MIDAS). From the sum of the scores, the volunteers

were classied as minimal disability (0-5 points), mild (6-10 points), were classied as minimal disability (0-5 points), mild (6-10 points),

moderate (11-20 points), and severe (> 20 points).moderate (11-20 points), and severe (> 20 points).

2424

The level of physical activity was veried by the International Physi-The level of physical activity was veried by the International Physi-

cal Activity Questionnaire (IPAQ), in its short version. It consists of cal Activity Questionnaire (IPAQ), in its short version. It consists of

four questions containing two sub-items that allowed measuring the four questions containing two sub-items that allowed measuring the

frequency, duration of activities, intensity during the week, and also frequency, duration of activities, intensity during the week, and also

the periods of inactivity of the participants. Among the categories the periods of inactivity of the participants. Among the categories

provided by IPAQ, it was possible to classify the volunteers as very provided by IPAQ, it was possible to classify the volunteers as very

active, active, irregularly active and sedentary, through data related active, active, irregularly active and sedentary, through data related

to the frequency and duration reported by them.to the frequency and duration reported by them.

2525

Statistical Analysis

The data were analyzed using the Statistical Package for Social The data were analyzed using the Statistical Package for Social

Sciences (SPSS) version 22.0. A descriptive analysis was performed Sciences (SPSS) version 22.0. A descriptive analysis was performed

with a calculation of the standard deviation for the averages of the with a calculation of the standard deviation for the averages of the

measurement variables and frequency of the other variables that measurement variables and frequency of the other variables that

characterize the sample. To test the normality of the variables, the characterize the sample. To test the normality of the variables, the

Shapiro-Wilk test was used. The Student t-test was used for variables Shapiro-Wilk test was used. The Student t-test was used for variables

with normal distribution and the Mann-Whitney test for variables with with normal distribution and the Mann-Whitney test for variables with

non-normal distribution. In the analysis of categorical variables, the non-normal distribution. In the analysis of categorical variables, the

chi-square test (chi-square test (cc

) was applied. The level of signicance considered ) was applied. The level of signicance considered

was p<0.05.was p<0.05.

Results

Of the 29 women evaluated, one was excluded for having another

type of headache and two for not completing the questionnaires. The

general characterization of the sample of the 26 included participants

(45.9 ± 7.9 years) and the clinical level of pain catastrophization

is shown in Table 1. There was no difference between the groups

regarding the time of diagnosis of bromyalgia.

Table 2 shows the characteristics of the sample in relation to the asso-

ciated symptoms. The presence of migraines had a serious impact on

the daily and professional life of half of the sample. When observing

the psychological characteristics of the studied population, it was

possible to identify that 76.93% of the volunteers had a degree of

depression from mild to moderate and 65.39% reported a moderate

to severe degree of anxiety.

Fibromyalgia Impact Questionnaire-Revised scores were signicantly

higher (p = 0.01) among women with catastrophization (78.0 ± 12.6)

than those without (56.6 ± 22.3). There was no difference between

groups (p> 0.05) in relation to the other outcomes assessed (Table 2).

Discussion

In the present study, only the perception of quality of life was associ-

ated with the presence of catastrophization in women with bromy-

algia and migraine. Despite the lack of association in relation to the

other outcomes studied, the results of our study are of great clinical

relevance, as they demonstrate that catastrophization can worsen

the perception of function, global impact, and intensity of symptoms

in patients with bromyalgia and migraine, generating negative

repercussions in the quality of life of this population. In addition, this

is a pioneering study, since the catastrophizing of pain has not yet

been analyzed in women with associated bromyalgia and migraine.

In the present study, more than half of women with bromyalgia and

migraine exhibited clinically relevant levels of pain catastrophization,

differing from the results of another study

, in which only a quarter of

the sample, composed of migrant women, presented this symptom. In

this way, it is possible that the presence of associated bromyalgia

and migraine, which share similar pathophysiological pathways

7,10

has contributed to greater susceptibility to pain, potentiating changes

in central processing and generating greater impact on catastroph-

izing symptoms.

Another relevant aspect, frequently cited in the literature, is that cata-

strophization provides a more intense experience of pain in patients

with chronic pain.

For this reason, women with the presence of

associated bromyalgia and migraine were expected to experience

greater pain intensity and changes in pain threshold.

6,7

Despite this,

in our study, no great variations were observed in the intensity of

pain due to migraine and bromyalgia.

On the other hand, our study showed that bromyalgia and migraine

women with catastrophization had greater impacts on the perception

of quality of life. It is known that both bromyalgia

and migraine

promote negative impacts on patients’ quality of life. Thus, the associ-

ASAA

Freire Barros AOF, Barbosa Barros MMMB, Santana RR, Wanderley D, Tenório AS, Oliveira DA

Main symptoms associated to the catastrophizing in women with fibromyalgia and migraine

ation between different disabling clinical conditions could aggravate

catastrophizing symptoms, making it difcult for the patient to deal

with the painful situation.

It is also often cited that women with bromyalgia are less physically

active than healthy women

, which could be explained by the fear

that bromyalgia patients have that physical activity could worsen

their symptoms.

In addition, people with high levels of catastroph-

ization may have worse physical performance

, probably due to

intolerance to pain-related activity.

Another common association is the presence of catastrophization,

sleep disorders

, and more severe degrees of depression and anx-

iety.

Despite the ndings, in our study the catastrophizing group

did not present lower levels of physical activity and no association

was observed with worsening migraine impact, sleep disorders,

depression, and anxiety. It is possible that the lack of association

between the variables studied in the present research is related to

the small sample size.

The results of the present study have some limitations. As it is an

observational study, it is not possible to establish cause-and-effect

relationships in this research. In addition, the small sample size

makes it impossible to perform statistical analysis with multiple linear

regression, which would make it possible to verify the inuence of

dependent variables with catastrophization.

Table 1. Characterization of the sample with and without the clinical level

of catastrophization.

Variables

Total sample (n

= 26)

Catastrophizing

With (n=18)

Without

(n=8)

Age (years) 45.92 ± 7.88 47.11 ± 7.79 43.25 ± 7.9 0.17

BMI (Kg/m

) 27.97 ± 4.94 28.09 ± 4.92 27.7 ± 5.32 1.00

Time of medication

(years)

3.95 ± 2.52 4.05 ± 2.51 3.62 ± 2.93 0.85

Time diagnosis of

bromyalgia (years)

7.42 ± 8.65 8.54 ± 10.04 4.88 ± 3.47 0.80

Race n(%)

White 9/26 (34.6) 5/26 (27.7) 4/8 (50)

Brown 13/26 (50.0) 11/26 (61.1) 2/8 (25)

Black 4/26 (15.3) 2/18 (11.1) 2/8 (25)

Marital status n(%)

Single 11/26 (42.3) 9/18 (50.0) 2/8 (25.0)

Married 12/26 (46.1) 7/18 (38.8) 5/8 (62.5)

Divorced 3/26 (11.5) 2/18 (11.1) 1/8 (12.5)

*Student t-test.

Data are presented as mean ± standard deviation or n (%). BMI – Body

Mass Index.

Table 2. Characterization of the sample with and without the clinical level

of catastrophization.

Variables Total sample (n=26)

Catastrophizing (n=18)

With (n=18) Without (n=8)

FIQ-R 71.42 ±18.68 78 ± 12.62 56.63 ± 22.30 0.01

PSQI 13.62 ± 4.36 14.5 ± 4.22 11.63 ± 4.27 0.11

MIDAS n(%)

Minimal

Disability

5/26 (19.3) 4/18 (22.2) 1/8 (12.5)

0.44

Light 3/26 (11.5) 2/18 (11.1) 1/8 (12.5)

Moderate 5/26 (19.2) 2/18 (11.1) 3/8 (37.5)

Severe 13/26 (50.0) 10/18 (55.0) 3/8 (37.5)

BDI n(%)

Absence (0-9) 1/26 (3.8) - 1/8 (12.5)

0.19

Light (10-18) 11/26 (42.3) 7/18 (38.8) 4/8 (50.0)

Moderate

(19-29)

9/26 (34.6) 6/18 (33.3) 3/8 (37.7)

Severe (>30) 5/26 (19.2) 5/18 (27.7) -

BAI n(%)

Minimal (0-10) 6/26 (23.0) 3/18 (16.6) 3/8 (37.5)

0.09

Light (11-19) 3/26 (11.5) 2/18 (11.1) 1/8 (12.5)

Moderate

(20-30)

8/26 (30.7) 4/18 (22.2) 4/8 (50.0)

Severe (>31) 9/26 (34.6) 9/18 (50.0) -

IPAQ n(%)

Very active - - -

0.11

Active 5/26 (19.2) 2/18 (11.1) 3/8 (37.5)

Irregularly

activa

14/26 (53.8) 12/18 (66.6) 2/8 (25.0)

Sedentary 7/26 (26.9) 4/18 (22.2) 3/8 (37.5)

* χ2 Test.Data are presented as mean ± standard deviation or n=number of

patients and (%). FIQ-R – Fibromyalgia Impact Questionnaire-Revised; PSQI

– Pittsburgh Sleep Quality Index; MIDAS – Migraine Disability Assessment

Test; BDI – Beck Depression Inventory; BAI – Beck Anxiety Inventory; IPAQ

– International Physical Activity Questionnaire.

Concl usion

The presence of catastrophization in women with bromyalgia and

migraine is associated with a worsening perception of quality of life.

The authors declare that there is no conict of interest

Place where the study was conducted: Departamento de Fisiotera-

pia, Laboratório de Aprendizagem e Controle Motor, Universidade

Federal de Pernambuco.

The research was approved by the Comitê de ética em pesquisa com

seres humanos do Centro de Ciências da Saúde from - UFPE (CAAE

37052114.3.0000.5208).

ASAA

Freire Barros AOF, Barbosa Barros MMMB, Santana RR, Wanderley D, Tenório AS, Oliveira DA

Main symptoms associated to the catastrophizing in women with fibromyalgia and migraine

References

1. Queiroz LP. Worldwide epidemiology of bromyalgia topical

collection on bromyalgia. Curr Pain Headache Rep. 2013;

17: 356.

2. Wolfe F, Smythe HA, Yunus MB, et al. The American Colle-

ge of Rheumatology 1990 Criteria for the Classication of

Fibromyalgia. Report of the Multicenter Criteria Committee.

Arthritis Rheum. 1990; 33: 160–72.

3. Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College

of Rheumatology preliminary diagnostic criteria for bromyal-

gia and measurement of symptom severity. Arthritis Care Res.

2010;62: 600–10.

4. Wolfe F. New American College of Rheumatology criteria for

bromyalgia: A twenty-year journey. Arthritis Care Res. 2010;

62: 583-4.

5. Bellato E, Marini E, Castoldi F, et al. Fibromyalgia syndrome:

etiology, pathogenesis, diagnosis, and treatment. Pain Res Treat.

2012; 2012: 1–17.

6. Silva LC, Oliveira DA, Martins HAL, et al. Fibromigrânea: uma

nova denominação para uma velha doença? Headache Med.

2011; 2: 89–95.

7. Valença MM, Medeiros FL, Martins HA, et al. Neuroendocrine

dysfunction in bromyalgia and migraine. Curr Pain Headache

Rep. 2009; 13: 358–64.

8. Arnold LM, Croord LJ, Mease PJ, et al. Patient perspectives on

the impact ofbromyalgia. Patient Educ Couns. 2008; 73: 1

14–20.

9. Stuginski-barbosa J, Dach F, Speciali JG. Relação entre cefaleia

primária e bromialgia: revisão de literatura. Rev Bras Reumatol.

2007; 47: 114–20.

10. Sullivan MJ, Thorn B, Haythornthwaite JA, et al. Theoretical

perspectives on the relation between catastrophizing and pain.

Clin J Pain. 2001; 17: 52–64.

11. Edwards RR, Cahalan C, Mensing G, et al. Pain, catastro-

phizing, and depression in the rheumatic diseases. Nat Rev

Rheumatol. 2011; 7: 216–24.

12. Severeijns R, Vlaeyen JW, van den Hout M a, et al. Pain catas-

trophizing predicts pain intensity, disability, and psychological

distress independent of the level of physical impairment. Clin J

Pain. 2001; 17: 165–72.

13. Bond DS, Buse DC, Lipton RB, et al. Clinical pain catastrophi-

zing in women with migraine and obesity. Headache. 2015;

57: 923–33.

14. Sullivan MJL, Rodgers WM, Wilson PM, et al. An experimental

investigation of the relation between catastrophizing and activity

intolerance. Pain. 2002; 100: 47–53.

15. Buenaver LF, Quartana PJ, Grace EG, et al. Evidence for indirect

effects of pain catastrophizing on clinical pain among myofas-

cial temporomandibular disorder participants: The mediating

role of sleep disturbance. Pain. 2012; 153: 1159–66.

16. Headache Classication Committee of the International He-

adache Society. The international classication of headache

disorders. Cephalalgia. 2013; 33: 629-808.

17. Sehn F, Chachamovich E, Vidor LP, et al. Cross-Cultural adap-

tation and validation of the brazilian portuguese version of the

pain. Pain Med. 2012; 13: 1425– 35.

18. Sullivan M, Bishop S, Pivik J. The pain catastrophizing scale:

development and validation. Psychol Assess. 1995; 7: 524–32.

19. Bertolazi AN, Fagondes SC, Ho LS, et al. Validation of the

Brazilian Portuguese version of the Pittsburgh Sleep Quality

Index. Sleep Med. 2011; 12: 70–5.

20. Gorenstein C, Andrade LHSG de. Inventário de depressão de

Beck: propriedades psicométricas da versão em português.

Arch Clin Psychiatry. 1998; 25: 245–50.

21. Cunha JA. Inventário de Depressão de Beck: Catálogo de

técnicas úteis. In Cunha JA (org.). Psicodiagnóstico. 5ed. Porto

Alegre: Artes Médicas; 2000.

22. Cunha JA. Manual da versão em português das Escalas de

Beck. São Paulo: Casa do Psicólogo. 2001; 256: 11-3

23. Paiva ES, Heymann RE, Rezende MC, et al. A Brazilian Portu-

guese version of the Revised Fibromyalgia Impact Questionnaire

(FIQR): A validation study. Clin Rheumatol. 2013; 32: 1199–206.

24. Stewart WF, Lipton RB, Dowson AJ, et al. Development and

testing of the Migraine Disability Assessment (MIDAS) Ques-

tionnaire to assess headache-related disability. Neurology.

2001; 56: 20–8.

25. Matsudo S, Araújo T, Matsudo V, et al. Questionário Interna-

cional de Atividade Física (IPAQ): estudo de validade e repro-

dutibilidade no Brasil. Rev Bras Ativ Fís Saúde. 2001; 6: 5-12.

26. Holroyd KA , Drew JB , Cottrell CK. Impaired functioning and

quality of life in severe migraine: the role of catastrophizing

and associated symptoms. Cephalalgia. 2007; 27: 1156–65.

27. McLoughlin MJ, Colbert LH, Stegner AJ. Are women with -

bromyalgia less physically active than healthy women? Med

Sci Sports Exerc. 2011; 43: 905–12.

28. Nijs J, Roussel N, Van Oosterwijck J, et al. Fear of movement

and avoidance behaviour toward physical activity in chronic-

-fatigue syndrome and bromyalgia: State of the art and impli-

cations for clinical practice. Clin Rheumatol. 2013; 32: 1121–9