Bigal M E, Sheftell F D, Rapoport A M, Tepper S J, Weeks R, Baskin S M
Department of Neurology, Albert Einstein College of Medicine, Rousso Building, 1165 Morris Park Avenue, Bronx, NY 10461, USA.
Neurol Sci. 2003 Oct;24(3):103-10. doi: 10.1007/s10072-003-0094-2.
We assessed the psychological profile of a large sample of patients with chronic daily headache (CDH) seen in tertiary care. We used a case-control design to study 791 patients who fell into the following categories: ARH group, chronic migraine with analgesic overuse (analgesic rebound headache, ARH), n=399; CM group, chronic migraine (CM) without analgesic overuse, n=158; and new daily persistent headache (NDPH) group, n=69. These groups were compared to two control groups: 1, migraine, n=100; 2, chronic posttraumatic headache (CPTH), n=65. We assessed personality and psychopathology with the Minnesota multiphasic personality inventory (MMPI)-2. The number of patients with Tscores > or =65 and < or =40 were analyzed by the two-sided Fischer's exact test. The ARH and CM groups had a higher number of subjects with T-scores > or =65, when compared to the migraine group, on the following scales: 1 (hypochondrias), 2 (depression), 8 (schizophrenia) and 0 (social introversion). No differences were observed between the NDPH and migraine groups. Considering CPTH as the control group, the pattern we found was quite the opposite of that described above: NDPH group presented a higher number of subjects with T-scores > or =65 on the following scales: 1, 2, 7 (psychasthenia) and 8. ARH and CM groups had significantly higher T-scores for scale 7 alone. NDPH showed T-scores < or =40 in scale 9 when compared to both control groups. We conclude that: (1) psychopathological factors are common in CDH patients, and appear to be a consequence of the chronification process; (2) low scores on scale 9 (hypomania) may relate to the development of NDPH; (3) psychopathological profiles differ among the subgroups of CDH and the MMPI-2 is reliable in identifying such patterns; and (4) psychological assessment is an essential step in the evaluation and treatment of patients with CDH.
我们评估了在三级医疗中心就诊的大量慢性每日头痛（CDH）患者的心理特征。我们采用病例对照设计，研究了791例患者，这些患者分为以下几类：药物过量使用性慢性偏头痛（ARH）组，即伴有镇痛药过度使用的慢性偏头痛（药物反弹性头痛，ARH），n = 399；慢性偏头痛（CM）组，即不伴有镇痛药过度使用的慢性偏头痛，n = 158；以及新发性每日持续性头痛（NDPH）组，n = 69。这些组与两个对照组进行比较：1. 偏头痛组，n = 100；2. 慢性创伤后头痛（CPTH）组，n = 65。我们使用明尼苏达多相人格调查表（MMPI）-2评估人格和精神病理学。对T分数≥65和≤40的患者数量进行双侧费舍尔精确检验分析。与偏头痛组相比，ARH组和CM组在以下量表上T分数≥65的受试者数量更多：量表1（疑病）、量表2（抑郁）、量表8（精神分裂症）和量表0（社会内向）。NDPH组和偏头痛组之间未观察到差异。将CPTH作为对照组，我们发现的模式与上述情况相反：NDPH组在以下量表上T分数≥65的受试者数量更多：量表1、量表2、量表7（神经衰弱）和量表8。仅量表7，ARH组和CM组的T分数显著更高。与两个对照组相比，NDPH在量表9上的T分数≤40。我们得出以下结论：（1）精神病理学因素在CDH患者中很常见，似乎是病程慢性化的结果；（2）量表9（轻躁狂）得分低可能与NDPH的发生有关；（3）CDH亚组之间的精神病理学特征不同，MMPI-2在识别此类模式方面是可靠的；（4）心理评估是CDH患者评估和治疗的重要步骤。
