A Prospective Observational Cohort Study on Pharmacological Habitus, Headache-Related Disability and Psychological Profile in Patients with Chronic Migraine Undergoing OnabotulinumtoxinA Prophylactic Treatment

Abstract

Chronic Migraine (CM) is a disabling neurologic condition with a severe impact on functioning and quality of life. Successful therapeutic management of patients with CM is complex, and differences in therapeutic response could be attributable to genetically determined factors, sensitivity to pharmacological treatment, psychosocial and relational factors affecting the patient’s compliance and approach on the therapeutic treatment. The aim of this prospective observational study was to explore self-efficacy, coping strategies, psychological distress and headache-related disability in a cohort of 40 patients with CM (mean age: 46.73; standard deviation 13.75) treated with OnabotulinumtoxinA and the relationship between these clinical and psychological aspects and acute medication consumption during OnabotulinumtoxinA prophylactic treatment. Patients presented an overall significant reduction in the Headache Index (HI) (p < 0.001), HI with severe intensity (p = 0.009), and total analgesic consumption (p = 0.003) after the prophylactic treatment. These results are in line with the literature. Despite this, higher nonsteroidal anti-inflammatory drugs consumption was associated with higher psychological distress, higher HI with severe and moderate intensity, and worse quality of life. Conversely, triptans consumption was correlated with HI of mild intensity, and problem-focused coping strategies. To conclude, the psychological profile, and in particular, the psychological distress and specific coping strategies might influence the self-management of acute medication.

Exploring Emotional Distress, Psychological Traits and Attitudes in Patients with Chronic Migraine Undergoing OnabotulinumtoxinA Prophylaxis versus Withdrawal Treatment

“…Therefore, identifying patients presenting psychological vulnerabilities is also essential during the OBT-A. On the one hand, it allows identifying patients with a poor predictor of OBT-A response, due to the presence of depression and psychological distress [53,58,59,61]. On the other hand, patients give more value, as assessed by clinicians, to the quality of life among OBT-A outcomes [68].…”

“…Despite the different level of headache frequency, self-efficacy resulted in being similar in both groups. Perceived self-efficacy has been considered a key factor in migraine management, adaptation to pain, prevention and management at the onset or in the course of headache attacks and resulted in being associated with headache-related disability [45,47,48,61]. Interestingly, only for patients undergoing OBT-A low level of perceived self-efficacy resulted in being associated with higher psychological distress.…”

“…The cross-sectional nature of the current study did not allow us to assess changes in psychological distress and factors over time, as previously discussed [61], or to verify whether OBT-A is influencing distress directly or due to CM relief. These aspects should be further explored in a longitudinal study evaluating psychological distress and factors from the baseline over OBT-A follow-up periodical injections.…”

“…Certain psychological features and personality traits (i.e., dependent trait) have been associated with OBT-A non-response in patients with CM [60]. In our previous study, we reported that specific coping strategies interfere with analgesic consumption and they are associated with different acute medication consumptions behaviors in patients with CM undergoing OBT-A [61].…”

“…A cross-sectional observational cohort study was performed from February 2018 to April 2019. The study is part of the project "EXploring PsychoLOgical needs of patients with chronic pain attending neuroREhabilitation services" (EXPLORE) [61]. Ethical approval to conduct the study was provided by the Ethics Committee of the Verona and Rovigo Province in Italy (approval date: 17 January 2018, 1630CESC, Prog.…”