Medication-overuse headache and personality: a controlled study by means of the MMPI-2.

OBJECTIVE: The main aim of this study involves comparing the personality profiles of patients with medication-overuse headache (MOH) and episodic headaches, in order to elucidate the role of personality characteristics, according to one of the most widely used and validated personality assessment tool: Minnesota Multiphasic Personality Inventory (MMPI-2). BACKGROUND: Many studies have assessed the personality of headache patients by means of MMPI-2 only using clinical and content scales. In this study the supplementary scales were also used as they evaluate different aspects of personality, particularly broad personality characteristics, generalized emotional distress and behavioral dyscontrol. METHODS: We recruited 219 subjects (151 women and 68 men) who were grouped in the following categories: MOH group (n = 82); episodic headache group (n = 82; 58 migraine aura; 6 migraine with aura; 6 frequent episodic tension-type headache; 12 migraine+infrequent episodic tension-type headache) and 1 group of 55 healthy controls. MMPI-2 was employed. Data were computed with one-way anova and post hoc analyses. RESULTS: Medication-overuse headache and episodic headache patients (EH) showed a very similar pattern, differentiating each other only in the Hypochondriasis (Hs) (P = .007; MOH: mean 14.18 [SD 5.53]; EH: mean 11.93 [SD 5.88] and Health Concerns [HEA]) (P = .005; MOH: mean 14.06 [SD 5.38]; EH: mean 11.81 [SD 5.59]) scales. Surprisingly, no differences were found between the 3 groups in the scales measuring dependence-related behavior such as Addiction Potential Scale (Aps) and Addiction Admission Scale (Aas). MOH and episodic headache patients scored significantly higher in the so-called neurotic scales Hs (P < .0001; MOH: mean 14.18 [SD 5.53]; EH: mean 11.93 [SD 5.88]; CONTROLS: mean 5.91 [SD 3.57]), Depression (D) (P < .0001; MOH: mean 26.44 [SD 7.01]; EH: mean 26.09 [SD 5.85]; CONTROLS: mean 21.47 [SD 4.90]), and Hysteria (Hy) (P < .0001; MOH: mean 27.33 [SD 5.51]; EH: mean 26.81 [SD 5.68]; CONTROLS: mean 21.95 [3.85]) and in many other scales such as Paranoia (Pa), Psychasthenia (Pt), Schizophrenia (Sc) while they scored significantly lower on Ego Strength (Es) and Dominance (Do) scales when compared with controls. CONCLUSIONS: Patients with MOH and episodic headache showed very similar patterns, differentiating only in the Hypochondriasis and Health Concerns scales. Surprisingly, there were no significant differences in the scores of the scales measuring dependence-related behavior. The clinical role of MMPI-2 in discriminating MOH patients with dependency from drugs is discussed, in order to implement a complete tests' battery for headache patients' assessment.

[Psychosomatic approach to patients with headache: alternative or integrated diagnoses?]. / Approccio psicosomatico al paziente cefalalgico: diagnosi alternativa o integrata?

Each person has an inseparable body-mind unity, with psychic factors that can also manifest themselves through changes in the functions of the body, and with changing somatic states that contribute to mental experience. This explains why somatic symptoms fall within psychiatry. When a patient complains about physical symptoms, it is essentially an integrated, multidisciplinary diagnosis which is used to identify the various factors (biological and psychological) which worsen the disorder, and a psychiatric dimensional approach is used to integrate the descriptive symptomatic diagnosis with the psychostructural diagnosis. The same symptoms, in fact, may underlie different psychological dynamics that direct the treatment and determine the prognosis, as explained in three clinical cases that we described. The literature on headaches reports a high rate of co-morbidity between migraines and psychiatric disorders, but doesn't take into account the fact that often the symptom of headache is part of the disorder, even when it presents on its own. In conclusion, a holistic approach is needed for the patient to be diagnosed as having a "psychiatric" form of headache. A medical examination of the illness leading to a diagnoses is essential, according to the criteria of the International Classification of Headache Disease (ICHD-II). In clinical practice, we have integrated the descriptive diagnosis (ICHD-II mini-Plus) with the psychological (Diagnostic Criteria of Psychosomatic Research - DCPR) and psycho-structural (Kenberg's interview, Minnesota Multiphasic Personality Inventory - MMPI) diagnoses. The clarification of the dynamics underlying the definition of symptoms and the role played by psychological factors has influenced the identification of therapeutic objectives and in the identification of the most appropriate strategies.