Psychiatric Comorbidity in the Evolution From Migraine to Medication Overuse Headache

Abstract

We set out to study the role of psychiatric comorbidity in the evolution of migraine to medication overuse headache (MOH) by a comparative study of 41 migraineurs (MIG) and 41 patients suffering from MOH deriving from migraine. There was an excess risk of suffering from mood disorders [odds ratio (OR) = 4.5, 95% confidence interval (CI) 1.5, 13.5], anxiety (OR = 5, 95% CI 1.2, 10.7) and disorders associated with the use of psychoactive substances other than analgesics (OR = 7.6, 95% CI 2.2, 26.0) in MOH compared with MIG. Retrospective study of the order of occurrence of disorders showed that in the MOH group, psychiatric disorders occurred significantly more often before the transformation from migraine into MOH than after. There was no crossed-family transmission between MOH and psychiatric disorders, except for substance-related disorders. MOH patients have a greater risk of suffering from anxiety and depression, and these disorders may be a risk factor for the evolution of migraine into MOH. Moreover, MOH patients have a greater risk of suffering from substance-related disorders than MIG sufferers. This could be due to the fact that MOH is part of the spectrum of addictive disorders.

Line bisection in medication-overuse and chronic tension-type headaches

“…In the current study, we also found that both anxiety and depression levels were higher in CTTH and MOH, which is consistent with previous reports [24][25][26][27][28]. Moreover, age correlates with the line bisection errors found in the current study were consistent with many previous reports [17], implying an age-related and right-(facial decision task) hemispheric dominant tasks [41].…”

“…In order to exclude the effect of chronic head pain, we have included a group of patients with CTTH. Bearing in mind that patients with generalized anxiety disorder bisected lines significantly leftward [23], and that both anxiety and depression are comorbid with MOH [24,25] and CTTH [26][27][28], we have used the Zung Self-Rating Anxiety Scale [29] and the Zung Self-Rating Depression Scale [30] to measure the anxiety and depression levels in our participants. the Zung 20-item Self-rating Anxiety Scale [29].…”

Correlation between migraine subtipes and depression

“…simple cases involve relatively short-term drug overuse, relatively modest amounts of overused medications, minimal psychiatric contribution, and no history of relapse after drug withdrawal. complex cases may involve long-term use of daily opioids or combination analgesics, multiple psychiatric co-morbidities such as personality disorders, addictive disorders and behavior of dependence and/or a history of relapse [17][18][19][20][21] . In the present study BDI scores were not statistically significant different between patients with and without medication overuse.…”

Fájdalomcsillapító-túlhasználathoz társuló fejfájás

“…Nem elhanyagolható a pszichológiai kockázati té-nyezők szerepe sem: az anticipátoros szorongás, illetve a hangulatzavar is hozzájárulnak a gyógyszerek túlzott mértékű fogyasztásának kialakulásához, illetve annak fenntartásához. Egy összehasonlító vizsgálat szerint az FTTF-betegek hangulatzavarra vonatkozó kockázata kö-rülbelül ötször, generalizált szorongásra való kockázata hatszor akkora volt, mint a migréneseké [28], és e betegségek a kórkép kialakulását megelőzték. Ugyanebben a vizsgálatban az FTTF-betegek pszichoaktív szerhaszná-latának kockázata csaknem nyolcszorosa volt a migréne-sekének: a szerhasználat a betegek 90%-ában korábbi keletű volt, mint az FTTF.…”