Medication‐Overuse Headache and Personality: A Controlled Study by Means of the MMPI‐2

Sances, Grazia; Galli, Federica; Anastasi, Serena; Ghiotto, Natascia; Giorgio, Giuseppina De; Guidetti, Vincenzo; Firenze, Caterina; Pazzi, Stefania; Quartesan, Roberto; Gallucci, Marcello; Nappi, Giuseppe

doi:10.1111/j.1526-4610.2009.01593.x

Cited by 36 publications

(37 citation statements)

References 58 publications

(142 reference statements)

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“…In keeping with other studies, no differences were found in personality traits between migraine patients and controls [23]. We did not observe a relationship between OF dysfunction and the patients’ education level or years of migraine, which in some studies have been suggested as risk factors for poor prognosis [24].…”

Section: Discussionsupporting

confidence: 89%

Orbitofrontal dysfunction predicts poor prognosis in chronic migraine with medication overuse

et al. 2011

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Chronic migraine patients are at risk of developing a medication overuse. Brain functional studies in these patients have demonstrated an orbitofrontal hypometabolism, persistent after overuse cessation. Orbitofrontal dysfunction is also present in addiction and thus could predispose migraineurs to medication overuse. The aim of this study was to investigate if orbitofrontal dysfunction can be demonstrated in patients with chronic migraine and medication overuse by performing a systematic neuropsychological evaluation focused on tests that assess frontal lobe function. Second, to establish whether it is related to the outcome of these patients. We prospectively studied 42 chronic migraine patients with medication overuse, 42 episodic migraineurs and 41 controls on a battery of neuropsychological tasks evaluating the orbitofrontal and dorsolateral functioning. Depression, anxiety, and personality traits were also assessed. Chronic migraineurs with medication overuse showed a significant impairment in orbitofrontal task performance and higher depression scores as compared to episodic migraineurs and controls. Dorsolateral dysfunction was present in both groups of migraneurs, who also had higher rates of anxiety as compared to controls. After 1 year of follow-up, migraine patient’s outcome was classified according to their medication overuse status. A negative outcome that included persistent or new-onset medication overuse was present in 34% of migraineurs and was associated with baseline poor orbitofrontal task performance, and with mild dorsolateral dysfunction, higher rates of depression, anxiety and neuroticism-anxiety traits. Formal education and years with migraine did not influence outcome. Orbitofrontal dysfunction is present in patients with chronic migraine and medication overuse, and associates with a poor outcome at 1 year of follow-up. Neuropsychological evaluation in migraine may help to detect patients prone to overuse so that appropriate therapeutic attitudes can be taken.Electronic supplementary materialThe online version of this article (doi:10.1007/s10194-011-0340-6) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 89%

Orbitofrontal dysfunction predicts poor prognosis in chronic migraine with medication overuse

et al. 2011

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“…This study was designed in agreement with the recent EFNS guidelines for the treatment of MOH (Evers and Jensen, 2011). Our study confirms previous observations about the occurrence of psychopathological disturbances in chronic headache patients with MOH (Radat et al, 2005;Atasoy et al, 2005;Sances et al, 2010;Galli et al, 2011). However, we did not find that VPA had a significant effect on psychopathological comorbidity, suggesting that its anti-migraine action is independent from its potential impact on the underlying psychopathology.…”

Section: Vpa Nsupporting

confidence: 88%

Sodium valproate in migraine without aura and medication overuse headache: A randomized controlled trial

Sarchielli

Messina

Cupini

et al. 2014

European Neuropsychopharmacology

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Objective: To assess the efficacy, safety and tolerability of sodium valproate (800 mg/die) compared with placebo in medication-overuse headache patients with a history of migraine without aura.Methods: This is a multicenter, randomized, double-blind, placebo-controlled study enrolled medication-overuse headache patients for a 3-month treatment period with sodium valproate (800 mg/day) or placebo after a 6 day outpatient detoxification regimen, followed by a 3-month follow-up. Primary outcome was defined by the proportion of patients achieving Z50% reduction in the number of days with headache per month (responders) from the baseline to the last 4 weeks of the 3-month treatment. Multivariate logistic regression models were used on the primary endpoint, adjusting for age, sex, disease duration, comorbidity and surgery. The last-observation-carried-forward method was used to adjust for missing values.Results: Nine sites enrolled 130 patients and, after a 6-day detoxification phase, randomized 88 eligible patients. The 3-month responder rate was higher in the sodium valproate (45.0%) than in the placebo arm (23.8%) with an absolute difference of about 20% (p=0.0431). Sodium valproate had safety and tolerability profiles comparable to placebo. Conclusions:The present study supports the efficacy and safety of sodium valproate in the treatment of medication overuse headache with history of migraine after detoxification.

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“…One study showed no difference in the personality profiles between CDH patients with MOH and those without MOH [28]. Another recent study revealed similar personality patterns in patients with MOH and those with episodic headache, with differences only on the Hypochondriasis and Health concerns scales, but both groups of patients differed from the control patients [29]. However, another study showed the frequency of OCD was significantly higher in MOH patients with preexisting migraine than in CDH patients without MOH [30].…”

Section: Personalitymentioning

confidence: 91%

“…Lauwerier et al [47•] suggested MOH was predominantly predicted by perceiving medication as needed and secondarily by scrutiny. One study failed to find any differences in the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scale measuring dependence among MOH patients, episodic migraine patients, and control patients [29]. They proposed that the DSM-IV criteria of dependence could be modified for patients with MOH and suggested that the criterion "A great deal of time spent to obtain substances" could be changed to compulsive drug-seeking behaviors in patients with MOH, such as obtaining medications from multiple providers, repeating episodes of prescription loss, and multiplying requests for early refills [29].…”

Section: Is Medication Overuse the Cause Or Consequence Of Chronic Damentioning

confidence: 95%

Dependent Behavior in Patients with Medication-Overuse Headache

Fuh

Wang

2011

Curr Pain Headache Rep

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Two thirds of patients with medication-overuse headache (MOH) fulfilled criteria for dependence on acute symptomatic treatments for pain, not exclusive of psychoactive medications, based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Several questionnaires have been used to assess dependent behavior in patients with MOH. Findings regarding underlying psychological profiles of dependence and MOH are not consistent. Nevertheless, several neuroimaging, genetic, and neurobiological studies support the existence of the common pathophysiological features of dependence and MOH and suggest a link between them. This review highlights recent studies on the relationship between dependence and MOH. This issue is important because it implies a treatment strategy in managing patients with MOH by providing the treatment of dependence.

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Medication‐Overuse Headache and Personality: A Controlled Study by Means of the MMPI‐2

Cited by 36 publications

References 58 publications

Orbitofrontal dysfunction predicts poor prognosis in chronic migraine with medication overuse

Orbitofrontal dysfunction predicts poor prognosis in chronic migraine with medication overuse

Sodium valproate in migraine without aura and medication overuse headache: A randomized controlled trial

Dependent Behavior in Patients with Medication-Overuse Headache

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