Migraine is associated with altered approach-avoidance decision processing: a case control study.
Overview
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
- Research Training Group 2660 “Approach-Avoidance”, University of Würzburg, Würzburg, Germany
- Department of Psychology I, University of Würzburg, Würzburg, Germany
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
Abstract
Background: Behavioral 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.
Methods: Individuals 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).
Results: Both 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.
Conclusions: Migraine 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.
Supplementary Information: The online version contains supplementary material available at 10.1186/
Reproduced under the paper's license (CC BY), from the paper cited above.
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Data
Datasets cited
- figshare:33012953, at figshare; found in DataCite
- figshare:33012956, at figshare; found in DataCite
- figshare:33012959, at figshare; found in DataCite
- figshare:33012962, at figshare; found in DataCite
- figshare:33012965, at figshare; found in DataCite
- figshare:33012968, at figshare; found in DataCite
- figshare:33012971, at figshare; found in DataCite
- figshare:33012974, at figshare; found in DataCite
- figshare:33012977, at figshare; found in DataCite
- figshare:33012980, at figshare; found in DataCite
- figshare:33012983, at figshare; found in DataCite
- figshare:33012986, at figshare; found in DataCite
- figshare:33012989, at figshare; found in DataCite
- figshare:33012992, at figshare; found in DataCite
Data availability
The datasets used and/
Reproduced under the paper's license (CC BY), from the paper cited above.
Versions
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Version 1, 27 September 2026: the first record
Recorded: type, language, journal, volume, issue, pages, dates, 3 authors, 8 keywords, 10 MeSH terms, 32 references.
Cite
This paper
Evers, S., Kübler, A., & Sommer, C. (2026). Migraine is associated with altered approach-avoidance decision processing: a case control study. The journal of headache and pain, 27(1), 183. https://
BibTeX
@article{evers2026migrai
author = {Evers, Sebastian and Kübler, Andrea and Sommer, Claudia},
title = {{Migraine is associated with altered approach-avoidance decision processing: a case control study}},
journal = {The journal of headache and pain},
year = {2026},
month = jul,
volume = {27},
number = {1},
pages = {183},
publisher = {BMC},
issn = {1129-2369},
doi = {10.1186/
url = {https://
pmid = {42464113},
pmcid = {PMC13377724}
}
RIS
TY - JOUR
AU - Evers, Sebastian
AU - Kübler, Andrea
AU - Sommer, Claudia
TI - Migraine is associated with altered approach-avoidance decision processing: a case control study
T2 - The journal of headache and pain
J2 - J Headache Pain
PY - 2026
DA - 2026/
VL - 27
IS - 1
SP - 183
SN - 1129-2369
PB - BMC
DO - 10.1186/
UR - https://
LA - en
ER -
CSL-JSON
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