Significance of Personality Profiles in PatientsWith Chronic Migraine
Significance of Personality Profiles in PatientsWith Chronic Migraine
Background and Objective: The aim of this study was to assess whether the psychological profile may have prognostic significance in chronic migraine patients.
Methods: The Minnesota Multiphasic Personality Inventory-2 was used for the psychological assessment of patients with chronic migraine to explore personality traits. Patients with psychiatric disease and medication overuse were excluded. One hundred and two patients completed the study. Migraine-related disability was measured using the Migraine Disability Assessment questionnaire at baseline (T0) and again after 2 years (T1), during which patients received prophylactic treatment for migraine. At T1 patients were classified into those exhibiting significant improvement (group 1: scores reduced by at least 50%) and those with unsatisfactory changes in headache-related disability (group 2: scores reduced by less than 50%).
Results: At T1 49 patients were in group 1 and 53 in group 2; at T0, group 1 patients had significantly lower Minnesota Multiphasic Personality Inventory-2 scores in the neurotic (hypochondriasis: P < .01; depression: P < .001; hysteria: P < .01) and schizophrenia (P < .05) scales. None of the other variables studied, ie, age, sex, age at migraine onset, number of years from chronic migraine onset, T0 Migraine Disability Assessment score, T0 headache frequency, severity and temporal pattern (continuous vs intermittent) differed significantly between the groups.
Conclusions: Findings suggest that psychological factors can influence the clinical course of chronic migraine and that psychological evaluation with Minnesota Multiphasic Personality Inventory-2 may be a reliable approach to obtain prognostic data and information for therapy planning in patients with chronic migraine.
The term chronic daily headache (CDH) is used to indicate conditions in which patients suffer from headache 15 days per month, or more frequently, for at least 4 hours a day.
Population-based studies have suggested that only 4% to 5% of the general population have a chronic form from the onset of their headache history. Since in most cases CDH evolves from an episodic headache form, more often migraine, chronic migraine (CM) is the most common type of CDH.
Psychopathological problems are prominent among patients with severe headache, especially among those with CDH. A very high percentage of patients with CM is depressed, and bidirectional influences may lead to an association between migraine and major depression. However, it is unclear whether psychopathological factors are significant for the onset and maintenance of CM or they are simply a consequence of the severe engagement provoked by the disease. A further question is whether specific personality profiles before treatment may predict its outcome. Personality assessment of CDH patients using the revised Minnesota Multiphasic Personality Inventory (MMPI-2) showed characteristic profiles on the hypochondriasis, depression, schizophrenia, and social introversion scales, while elevation of the depression and social introversion scales was found to correlate positively with biofeedback treatment outcome in headache patients. Although some researchers deny a prognostic role for pretreatment MMPI scores in treatment outcome, these data come from studies with a short follow-up of nonhomogeneous patient samples.
The present study addresses the possible prognostic significance of personality profiles in a group of patients with CM; this condition was selected due to the growing interest in finding possible targets for a multidisciplinary intervention in a migraine population characterized by a high rate of therapeutic failure.
Abstract
Background and Objective: The aim of this study was to assess whether the psychological profile may have prognostic significance in chronic migraine patients.
Methods: The Minnesota Multiphasic Personality Inventory-2 was used for the psychological assessment of patients with chronic migraine to explore personality traits. Patients with psychiatric disease and medication overuse were excluded. One hundred and two patients completed the study. Migraine-related disability was measured using the Migraine Disability Assessment questionnaire at baseline (T0) and again after 2 years (T1), during which patients received prophylactic treatment for migraine. At T1 patients were classified into those exhibiting significant improvement (group 1: scores reduced by at least 50%) and those with unsatisfactory changes in headache-related disability (group 2: scores reduced by less than 50%).
Results: At T1 49 patients were in group 1 and 53 in group 2; at T0, group 1 patients had significantly lower Minnesota Multiphasic Personality Inventory-2 scores in the neurotic (hypochondriasis: P < .01; depression: P < .001; hysteria: P < .01) and schizophrenia (P < .05) scales. None of the other variables studied, ie, age, sex, age at migraine onset, number of years from chronic migraine onset, T0 Migraine Disability Assessment score, T0 headache frequency, severity and temporal pattern (continuous vs intermittent) differed significantly between the groups.
Conclusions: Findings suggest that psychological factors can influence the clinical course of chronic migraine and that psychological evaluation with Minnesota Multiphasic Personality Inventory-2 may be a reliable approach to obtain prognostic data and information for therapy planning in patients with chronic migraine.
Introduction
The term chronic daily headache (CDH) is used to indicate conditions in which patients suffer from headache 15 days per month, or more frequently, for at least 4 hours a day.
Population-based studies have suggested that only 4% to 5% of the general population have a chronic form from the onset of their headache history. Since in most cases CDH evolves from an episodic headache form, more often migraine, chronic migraine (CM) is the most common type of CDH.
Psychopathological problems are prominent among patients with severe headache, especially among those with CDH. A very high percentage of patients with CM is depressed, and bidirectional influences may lead to an association between migraine and major depression. However, it is unclear whether psychopathological factors are significant for the onset and maintenance of CM or they are simply a consequence of the severe engagement provoked by the disease. A further question is whether specific personality profiles before treatment may predict its outcome. Personality assessment of CDH patients using the revised Minnesota Multiphasic Personality Inventory (MMPI-2) showed characteristic profiles on the hypochondriasis, depression, schizophrenia, and social introversion scales, while elevation of the depression and social introversion scales was found to correlate positively with biofeedback treatment outcome in headache patients. Although some researchers deny a prognostic role for pretreatment MMPI scores in treatment outcome, these data come from studies with a short follow-up of nonhomogeneous patient samples.
The present study addresses the possible prognostic significance of personality profiles in a group of patients with CM; this condition was selected due to the growing interest in finding possible targets for a multidisciplinary intervention in a migraine population characterized by a high rate of therapeutic failure.
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