Outcome of patients with chronic migraine with medication overuse and depression after duloxetine: influence of coexisting obsessive compulsive disorder

Abstract

Patients with chronic migraine (CM) and medication overuse (MO) have high frequency of psychiatric comorbidity. Aims of this open label, prospective, independent study were: to evaluate the efficacy of duloxetine in a sample of patients with MO due to CM and with concomitant depression; to investigate, if the presence of OCD influences the outcome in this subgroup of patients. A total of 50 consecutive patients (40 F,10 M, aged 20-65 years, mean 39.4 years) from those attending our Headache Center to undergo an inpatient withdrawal programme followed by anti-migraine prophylaxis was enrolled. After a 1-month baseline period, all patients were prescribed duloxetine 30 mg in the morning for the first week, and 60 mg for the following 12 weeks. They filled a daily headache diary during the whole study period. They also completed Hamilton depression rating scale (HDRS) and migraine disability assessment scale (MIDAS) at baseline and at the 12-week follow-up. The primary outcome measure was the percentage of responders, i.e. of patients with a reduction C50 % in headache frequency as well as in symptomatic drug consumption. Comparison between patients with and without OCD was performed. Our results showed a rather high responder rate in the total sample (64 %), while none of the patients with OCD fell among responders. MIDAS and HDRS scores had a more evident decrease in patients without OSD. These findings suggest that duloxetine may be effective in patients with MO due to CM and with comorbid depression. They also confirm the importance of a systematic assessment of the psychopathological profile in these patients, and indicate that clinicians should be aware of the relevant prognostic role of OCD in favoring a poor outcome and persistent disability in headache patients with MO.

Health and quality of life in patients with medication overuse headache syndrome after standardized inpatient rehabilitation

“…MOH was associated with obsessive-compulsive disorders; in one study, the prevalence of the latter was 28%. [ 60 ] Psychiatric comorbidities are predictors for prognosis and response to treatment. [ 60 – 62 ] A small study showed a significantly increased risk of suffering from overall mood disorders (odds ratio, OR = 4.5), anxiety (OR = 5.0) and disorders associated with the use of psychoactive substances other than analgesics (OR = 7.6) in MOH sufferers when compared to patients with migraine only (n = 41 in both groups).…”

“…[ 60 ] Psychiatric comorbidities are predictors for prognosis and response to treatment. [ 60 – 62 ] A small study showed a significantly increased risk of suffering from overall mood disorders (odds ratio, OR = 4.5), anxiety (OR = 5.0) and disorders associated with the use of psychoactive substances other than analgesics (OR = 7.6) in MOH sufferers when compared to patients with migraine only (n = 41 in both groups). [ 63 ] The HADS anxiety score of 63.3 in our study is comparable to a 3-month follow-up score of 66.7 [ 62 ] and a 6-month follow-up score of 66.2, [ 56 ] whereas the depression score in our study (67.6) is lower when compared to the aforementioned studies (81.0 at 3-month follow-up; 80.4 at 6-month follow-up).…”

Changes in anxiety and depression symptoms associated to the outcome of MOH: A post-hoc analysis of the Comoestas Project

“…The main finding of this study is that symptoms of depression and anxiety in MOH patients are significantly reduced by the treatment proposed (drug withdrawal followed by optional prophylactic treatment) and that such reduction varies according to the type of outcome. Some authors (11,28,29) previously reported changes in psychiatric comorbidities after detoxification, but they did not differentiate this reduction as a function of the outcome. What is interesting in our study is that such a decrease is related to the success of the treatment itself.…”

The Importance of Psychopathological Assessment in Patients with Migraine

“…One of Curone's most recent studies [4] confirmed the hypothesis that obsessive-compulsive trait is a predictive factor of poor response in patients overusing medication, leading to chronic migraine and comorbid depression. Curone used drugs to treat major depressive disorders like duloxetine, in order to drop the frequency of migraine attacks and to limit the overuse of medication in chronic migraine patients with comorbid depression by decreasing their depression scores.…”