Personality traits in chronic daily headache patients with and without psychiatric comorbidity: an observational study in a tertiary care headache center

Abstract

BackgroundPrevious studies suggest that patients with Chronic Daily Headache (CDH) have higher levels of anxiety and depressive disorders than patients with episodic migraine or tension-type headache. However, no study has considered the presence of psychiatric comorbidity in the analysis of personality traits. The aim of this study is to investigate the prevalence of psychiatric comorbidity and specific personality traits in CDH patients, exploring if specific personality traits are associated to headache itself or to the psychiatric comorbidity associated with headache.MethodsAn observational, cross-sectional study. Ninety-four CDH patients with and without medication overuse were included in the study and assessed by clinical psychiatric interview and Mini International Neuropsychiatric Interview (M.I.N.I.) as diagnostic tools. Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Hamilton Depression Rating Scale (HAM-D) were afterwards administered. Patients with and without psychiatric comorbidity were compared. Further analyses were made by splitting the whole group according to the headache diagnosis and the presence or not of medication overuse.ResultsPsychiatric comorbidity was detected in 44 patients (46.8%) (group A) and was absent in the remaining 50 patients (53.2%) (group B). Mood and anxiety disorders were the most frequently diagnosed (43.6%).In the overall group, mean scores of MMPI-2 showed a high level in the so-called neurotic triad; in particular the mean score in the Hypochondriasis subscale was in the pathologic area (73.55 ± 13.59), while Depression and Hysteria scores were moderate but not severe (62.53 and 61.61, respectively). In content scales, score in Health Concern was also high (66.73).Group A presented higher scores compared to Group B in the following MMPI-2 subscales: Hypochondriasis (p = .036), Depression (p = .032), Hysteria (p < .0001), Hypomania (p = .030). Group B had a high score only in the Hypochondriasis subscale. No significant differences were found between chronic migraine (CM)-probable CM (pCM) plus probable medication overuse headache (pMOH) and chronic tension-type headache (CTTH)-probable CTTH (pCTTH) plus pMOH patients or between patients with and without drug overuse.ConclusionsThe so-called “Neurotic Profile” reached clinical level only in CDH patients with psychiatric comorbidity while a high concern about their general health status was a common feature in all CDH patients.

Psychometric properties of the stagnation scale in medication overuse headache patients

“…MOH is often comorbid with emotional disturbances and disordered personality traits [ 12 , 13 ], which seem to play a role in the evolution of migraine to MOH and are associated with poorer outcomes [ 14 ]. Psychological disturbances may also be risk factors for a later development of MOH; for example, a prospective 11-year longitudinal study demonstrated that anxiety and depression with musculoskeletal and gastrointestinal complaints were risk factors for MOH, but not for chronic headache (i.e., a form of headache with attacks occurring 15 or more days per month for at least 3 months) without medication overuse [ 15 ].…”

Treatment of medication overuse headache—A review

“…1,2 It develops in some patients with a preexisting headache disorder, most often migraine or tension-type headache, and is a consequence of an overuse of any type of analgesics or migraine-specific medication that can be used to treat headache 3 (Table 1) and is associated with low socioeconomic status 4,5 and has been linked to dependence-related behavior, 6,7 stress, and unhealthy lifestyle, 8 and thus, the patient population with MOH varies greatly. 1,2 It develops in some patients with a preexisting headache disorder, most often migraine or tension-type headache, and is a consequence of an overuse of any type of analgesics or migraine-specific medication that can be used to treat headache 3 (Table 1) and is associated with low socioeconomic status 4,5 and has been linked to dependence-related behavior, 6,7 stress, and unhealthy lifestyle, 8 and thus, the patient population with MOH varies greatly.…”

“…Medication overuse headache (MOH) is the most prevalent chronic headache disorder. 1,2 It develops in some patients with a preexisting headache disorder, most often migraine or tension-type headache, and is a consequence of an overuse of any type of analgesics or migraine-specific medication that can be used to treat headache 3 (Table 1) and is associated with low socioeconomic status 4,5 and has been linked to dependence-related behavior, 6,7 stress, and unhealthy lifestyle, 8 and thus, the patient population with MOH varies greatly.…”

Psychological Approaches to Headache

“…Medication overuse was not a significant factor. 56 Galli and associates have shown that medication overuse headache (MOH) patients and pure substance abusers do not share dependency characteristics on the MMPI-2. 57 There may be two separate profiles in medication overuse headache patients with a more complex group exhibiting significant dependency features and who are more likely to abuse opioid analgesics.…”