Clinical and psychoemotional characteristics of patients with medication overuse headache

Abstract

The available data indicate the important role of personality profile, psychoemotional disorders and psychosocial aspects in the development and maintenance of medication overuse headache (MOH). It is therefore important to identify predictors for the development and factors that influence the course and prognosis of treatment for this disorder.Objective: to analyze the clinical and psychological profile of patients and to identify predictors of the course of MOH in order to develop a prognostic model.Material and methods. We performed a comparative analysis of the characteristics of 117 patients with MOH (group 1) and 23 patients with chronic migraine (CM) without MOH (group 2) using clinical data and questionnaire data to determine the neuropsychological profile (PCS, Spielberger-Khanin Anxiety Scale, PHQ-9, BIS-11, TAS-26, SAGE test, Leeds Dependence Questionnaire – LDQ) at the time of admission to hospital and 9 months after the start of treatment.Results. The study showed that 100% of patients with CM and MOH had various psychoemotional disorders. At the same time, the pre-therapy baseline indicators for the level of personal anxiety, pain catastrophizing scales, impulsive behavior, alexithymia and LDQ parameters were significantly higher in the group of patients with CM and MOH than in the group with CM without excessive analgesic use. Using multiple linear regression, it was found that an increase in the severity of depression by 1 point is significantly associated with an increase in the number of days with headache (HA) by 0.33 days per month. In addition, a significant direct correlation was found between the degree of addiction according to LDQ and the extent of pain catastrophizing and situational anxiety, as well as the level of cognitive functions (according to the SAGE questionnaire) in an inverse relationship. At the same time, the frequency of analgesics use per day in the group of patients with CM and MOH is significantly related to the level of pain catastrophizing, depression and personal anxiety.Conclusion. The results obtained confirm the biobehavioral concept of MOH development. Effective therapy of the primary form of HA (in our study – CM) is significantly associated with a decrease in the severity of anxiety, depression, catastrophizing and the frequency of taking analgesics. Personality traits, especially the tendency to impulsive behavior, remain unchanged against the background of chronic HA treatment. The presented results emphasize the need for complex treatment of patients with CM and MOH.