Borderline Personality Disorder and Migraine

Abstract

Background.-Borderline personality disorder (BPD) may be disproportionately common in the migraine patient population, but specific migraine features in the BPD subgroup remain incompletely characterized.Purpose.-To define more clearly the clinical characteristics of migraine patients with BPD, to evaluate their clinical response to aggressive headache management, and to assess the sensitivity of an instrument intended to screen for the presence of BPD.Methods.-We evaluated 50 consecutive patients with migraine and previously documented BPD, 50 consecutive patients with migraine of all types and no history of BPD, and 50 patients with migraine and no history of BPD matched to the first group for age, gender, and headache frequency. We assessed a variety of demographic and clinical variables at baseline, and to all patients we administered the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Patients in Groups 1 and 3 were treated for their headaches via a uniform pharmacologic management program. Treatment outcome was assessed after 6 months.Results.-In this series of migraine patients, coexisting BPD was associated with female gender, more pervasive headache, more migraine-related disability, a higher prevalence of medication overuse headache, more unscheduled visits for acute migraine treatment, a higher prevalence of active, self-reported depression, and a lower likelihood of responding to pharmacologic therapy intended for headache management. The MSI-BPD was insensitive in detecting BPD.Conclusions.-Migraine patients with coexisting BPD are clinically distinct from the migraine patient population as a whole; in particular, they are more severely affected by their headache disorder and more treatment refractory. Simple screening instruments used to detect BPD may be ineffective in the headache clinic setting.

Personality traits, personality disorders, and migraine: a review

“…Presence of BPD is associated with more pervasive headache, high migraine-related disability, significant comorbid depression, and a high frequency of unscheduled visits for acute pharmacologic treatment [31]. Several studies underscore the negative impact of personality disorders on headache medication use.…”

“…Several studies underscore the negative impact of personality disorders on headache medication use. Specifically, BPD patients often have a poor response to prophylactic migraine treatments and a high prevalence of medication overuse headache (MOH) [31]. OCPD also appears to be a risk factor for development of MOH [28].…”

Dependency-like behaviors and pain coping styles in subjects with chronic migraine and medication overuse: results from a 1-year follow-up study

“…Mood disorders including depression have been considered relapse-predicting factors [13]: a 4-year follow-up study conducted by Hagen et al found that lower scores for depressive symptoms at baseline were the only factor associated with functional improvement [14]. Furthemore, dysfunctional personality traits have been related to worsened long-term prognosis in subjects with CM , and might facilitate the perpetuation of medication consumption [15,16]. Third, the severity of dependency-like behaviors could dampen the benefits of detoxification and increase risk to fall into CMwMO [17].…”

Psychological Approaches to Headache

“…99 In one clinical study, a diagnosis of borderline personality disorder was associated with more pervasive headache, high headache-related disability, lower probability of responding to standard preventive pharmacological therapy, and greater risk for medication overuse. 100 Although comorbid depression and anxiety are associated with poorer functioning and quality of life in people with migraine, 71,92 individuals with migraine and comorbid depression and/or anxiety can experience significant improvement in migraine over the course of comprehensive treatment. 101 Behavioral/psychological treatments for migraine as well as anxiety and depression share similar goals.…”