Evidence map›Paper›PMID 42464113›Full record

ArticleThe journal of headache and pain2026

Migraine is associated with altered approach-avoidance decision processing: a case control study.

Sebastian Evers, Andrea Kübler, Claudia Sommer

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Article in The journal of headache and pain, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

3 authors.

Sebastian EversDepartment of Neurology, University Hospital Würzburg, Würzburg, Germany. sebastian.evers@posteo.de.
Andrea KüblerResearch Training Group 2660 "Approach-Avoidance", University of Würzburg, Würzburg, Germany.
Claudia SommerDepartment of Neurology, University Hospital Würzburg, Würzburg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBehavioral management of migraine has traditionally emphasized trigger avoidance, although emerging evidence supports a shift toward more confrontative coping strategies. Understanding how individuals with migraine process and respond to trigger-related information in approach-avoidance situations is critical for developing targeted interventions.

methodsIndividuals with migraine and migraine-free controls were exposed to visual trigger-related and neutral stimuli prior to making approach-avoidance decisions in an adapted virtual T-maze paradigm. Behavioral measures included decision time (DT) and initial movement response (IMR). Neurophysiological activity was assessed through high-density EEG focusing on frontal alpha asymmetry (FAA), frontal midline theta activity (FMT), and functional connectivity as indexed by the debiased weighted phase lag index (dwPLI).

resultsBoth groups achieved comparable overall performance. Individuals with migraine exhibited significantly prolonged decision times (DTs), particularly in avoidance and high-conflict conditions, indicating increased cognitive demand. This effect was contrary to the initial hypothesis. Importantly, indirect trigger confrontation did not significantly influence avoidance behavior or decision times, nor did it modulate EEG measures, indicating a robust null effect. As secondary results, neurophysiological analyses revealed reduced FAA and FMT activity as well as situation-dependent alterations in dwPLI-based functional connectivity, providing converging evidence for altered regulatory control and increased neural excitability in migraine.

conclusionsMigraine is associated with altered approach-avoidance decision processing characterized by increased cognitive demand and impaired regulatory control. Indirect trigger confrontation appears insufficient to systematically modulate these processes within the present paradigm. These findings indicate alterations in decision-making dynamics in migraine. Further research using simpler behavioral paradigms and the utilization of neuromodulation strategies targeting FAA and FMT are required.

Indexed as

Avoidance LearningDecision MakingMigraine DisordersAdultCase-Control StudiesElectroencephalographyFemaleHumansMaleYoung AdultApproach and avoidanceBehavioralFrontal-alpha-asymmetryFrontal-midline-thetaFunctional connectivityHigh-density EEGMigraineTrigger confrontation

Identifiers

PMID42464113
PMCPMC13377724

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.