Medication-Overuse Headache Sufferers vs Drug Addicts
Medication-Overuse Headache Sufferers vs Drug Addicts
Background.— Medication-overuse headache (MOH) refers to headache attributed to excessive use of acute medications. The role of personality needs studies to explain the shifting from drug use to drug abuse. The main aim of this study is to study personality, according to Minnesota Multiphasic Personality Inventory, comparing MOH, episodic headache, substance addicts (SA) vs healthy controls.
Methods.— Eighty-two MOH patients (mean age 44.5; 20 M, 62 F) and 35 episodic headache (mean age 40.2; 8 M, 27 F), were compared to 37 SA (mean age 32.5; 29 M, 8 F) and 37 healthy controls (mean age: 32.49; 20 M, 17 F). International Classification of Headache Disorders 2nd Edition criteria were employed. Chi-square test, Kruskal-Wallis test, and post hoc comparisons were used for statistics.
Results.— MOH patients scored higher on Hypochondriasis, Depression (only females), Hysteria (only females) (P < .000). MOH did not show higher scores than episodic headache or healthy controls in dependency scales, while SA did.
Conclusion.— The data obtained show that MOH and SA do not share common personality characteristics linked to dependence. Although further studies are needed to understand if such a difference is related to instrumental characteristics or to yet undiscovered psychobiological characteristics of MOH patients; however, we hypothesize that the detected difference may rely on the fact that drug dependence in the 2 groups is promoted by entirely different needs: pleasure seeking in the SA group, pain avoidance in the MOH group.
Medication-overuse headache (MOH) presents headache specialists with several challenges from etiological, nosographic, pathophysiological, and therapeutic points of view. The estimated prevalence of MOH is 1–2% in the general population, being higher in women (2.6%, rising to 5% among women in their fifth decade of life) and lower in men (0.19%). In headache center populations, patients with MOH represent 55–70% of the consulting population. MOH is, therefore, a common condition representing a growing health problem all over the world and determining considerable long-term morbidity and disability. The term MOH first appeared in the International Classification of Headache Disorders 2nd Edition (ICHD-II). To fulfill ICHD-II diagnostic criteria, MOH patients should have at least 15 headache days/month and regular overuse of acute headache medication for at least 3 months. Furthermore, headache should have developed or markedly worsened during medication overuse. For analgesics, the criterion of "regular overuse" is met when these drugs are taken on at least 15 days/month. ICHD-II further lists other types of MOH for those subjects overusing ergotamine, opioids, combinations of drugs and drugs in combination. For these drugs overuse is defined as intake on at least 10 days/month for at least 3 months. While treatment strategies are debated (ie, inpatient vs outpatient, the starting of preventive therapy during or after withdrawal, usefulness of replacement therapy), it is generally agreed that abrupt drug withdrawal should be the first therapeutic step. The relapse rates are estimated to occur (mainly during the first year) in 30% to 45% of patients with MOH. Usually, MOH develops from a primary headache diagnosis: a meta-analysis of studies on MOH patients showed that the headache diagnosis at onset is migraine in 65% of patients, tension-type headache in 27%, and mixed or other headaches in 8%.
The understanding of factors involved in the prognosis of MOH is a key-point of the current debate. The presence of psychiatric comorbidity is a negative prognostic factor for headache improvement or resolution. Headache patients often show psychiatric comorbidity, an important factor for the transformation of episodic headache into chronic headache, in MOH patients, too. While a role of psychiatric disorders in chronic headache is well established, fewer studies addressed personality characteristics and disorders. Some studies evidenced the role of specific personality characteristics in MOH patients (eg, obsessive-compulsive personality disorder), while others suggested that MOH appears to belong to the spectrum of addictive behaviors. This topic requires a more precise definition because of its critical importance in preventing relapsing. If patients show problems of psychological addiction, this needs to be managed in the implementation of a complete therapeutic planning. The existence of personality characteristics linked to the clinical addiction may be distinguished from the presence of behaviors influenced by the need of coping with recurrent and disabling pain. The study of personality characteristics of MOH patients may help in discriminating between dependence as a personality-related problem and dependence as a behavioral consequence of coping with recurrent pain. Descriptively, personality means "enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts." Theorists generally assume that: (1) traits are relatively stable over time; (2) traits differ among individuals (eg, some people are outgoing while others are reserved); (3) traits influence behavior.
The main aim of this study was to provide a detailed view of MOH patients' personality characteristics and psychopathology, by means of one of the most widely used and validated personality assessment tools in a number of clinical and research fields, including pain and addictive behaviors, the Minnesota Multiphasic Personality Inventory (MMPI-2). We assessed the personality profiles of MOH patients compared to substance addicts (SA), episodic headache (EH) patients, and healthy controls (HC) in order to investigate whether specific personality and psychopathological characteristics are found in MOH. We expressly used the supplementary scales of MMPI-2, in addition to clinical and content scales, paying particular attention to those specifically constructed to detect substance use proneness (ie, MacAndrew Alcoholism Scale-Revised [Mac-R], Addiction Admission Scale [Aas], and Addiction Potential Scale [Aps]).
Abstract and Introduction
Abstract
Background.— Medication-overuse headache (MOH) refers to headache attributed to excessive use of acute medications. The role of personality needs studies to explain the shifting from drug use to drug abuse. The main aim of this study is to study personality, according to Minnesota Multiphasic Personality Inventory, comparing MOH, episodic headache, substance addicts (SA) vs healthy controls.
Methods.— Eighty-two MOH patients (mean age 44.5; 20 M, 62 F) and 35 episodic headache (mean age 40.2; 8 M, 27 F), were compared to 37 SA (mean age 32.5; 29 M, 8 F) and 37 healthy controls (mean age: 32.49; 20 M, 17 F). International Classification of Headache Disorders 2nd Edition criteria were employed. Chi-square test, Kruskal-Wallis test, and post hoc comparisons were used for statistics.
Results.— MOH patients scored higher on Hypochondriasis, Depression (only females), Hysteria (only females) (P < .000). MOH did not show higher scores than episodic headache or healthy controls in dependency scales, while SA did.
Conclusion.— The data obtained show that MOH and SA do not share common personality characteristics linked to dependence. Although further studies are needed to understand if such a difference is related to instrumental characteristics or to yet undiscovered psychobiological characteristics of MOH patients; however, we hypothesize that the detected difference may rely on the fact that drug dependence in the 2 groups is promoted by entirely different needs: pleasure seeking in the SA group, pain avoidance in the MOH group.
Introduction
Medication-overuse headache (MOH) presents headache specialists with several challenges from etiological, nosographic, pathophysiological, and therapeutic points of view. The estimated prevalence of MOH is 1–2% in the general population, being higher in women (2.6%, rising to 5% among women in their fifth decade of life) and lower in men (0.19%). In headache center populations, patients with MOH represent 55–70% of the consulting population. MOH is, therefore, a common condition representing a growing health problem all over the world and determining considerable long-term morbidity and disability. The term MOH first appeared in the International Classification of Headache Disorders 2nd Edition (ICHD-II). To fulfill ICHD-II diagnostic criteria, MOH patients should have at least 15 headache days/month and regular overuse of acute headache medication for at least 3 months. Furthermore, headache should have developed or markedly worsened during medication overuse. For analgesics, the criterion of "regular overuse" is met when these drugs are taken on at least 15 days/month. ICHD-II further lists other types of MOH for those subjects overusing ergotamine, opioids, combinations of drugs and drugs in combination. For these drugs overuse is defined as intake on at least 10 days/month for at least 3 months. While treatment strategies are debated (ie, inpatient vs outpatient, the starting of preventive therapy during or after withdrawal, usefulness of replacement therapy), it is generally agreed that abrupt drug withdrawal should be the first therapeutic step. The relapse rates are estimated to occur (mainly during the first year) in 30% to 45% of patients with MOH. Usually, MOH develops from a primary headache diagnosis: a meta-analysis of studies on MOH patients showed that the headache diagnosis at onset is migraine in 65% of patients, tension-type headache in 27%, and mixed or other headaches in 8%.
The understanding of factors involved in the prognosis of MOH is a key-point of the current debate. The presence of psychiatric comorbidity is a negative prognostic factor for headache improvement or resolution. Headache patients often show psychiatric comorbidity, an important factor for the transformation of episodic headache into chronic headache, in MOH patients, too. While a role of psychiatric disorders in chronic headache is well established, fewer studies addressed personality characteristics and disorders. Some studies evidenced the role of specific personality characteristics in MOH patients (eg, obsessive-compulsive personality disorder), while others suggested that MOH appears to belong to the spectrum of addictive behaviors. This topic requires a more precise definition because of its critical importance in preventing relapsing. If patients show problems of psychological addiction, this needs to be managed in the implementation of a complete therapeutic planning. The existence of personality characteristics linked to the clinical addiction may be distinguished from the presence of behaviors influenced by the need of coping with recurrent and disabling pain. The study of personality characteristics of MOH patients may help in discriminating between dependence as a personality-related problem and dependence as a behavioral consequence of coping with recurrent pain. Descriptively, personality means "enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts." Theorists generally assume that: (1) traits are relatively stable over time; (2) traits differ among individuals (eg, some people are outgoing while others are reserved); (3) traits influence behavior.
The main aim of this study was to provide a detailed view of MOH patients' personality characteristics and psychopathology, by means of one of the most widely used and validated personality assessment tools in a number of clinical and research fields, including pain and addictive behaviors, the Minnesota Multiphasic Personality Inventory (MMPI-2). We assessed the personality profiles of MOH patients compared to substance addicts (SA), episodic headache (EH) patients, and healthy controls (HC) in order to investigate whether specific personality and psychopathological characteristics are found in MOH. We expressly used the supplementary scales of MMPI-2, in addition to clinical and content scales, paying particular attention to those specifically constructed to detect substance use proneness (ie, MacAndrew Alcoholism Scale-Revised [Mac-R], Addiction Admission Scale [Aas], and Addiction Potential Scale [Aps]).
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