Department of Clinical Neurosciences, Neurological Institute C Besta, IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy.
Neurol Sci. 2012 May;33 Suppl 1:S211-3. doi: 10.1007/s10072-012-1070-5.
Patients with chronic migraine (CM) and medication overuse (MO) have a high frequency of psychiatric comorbidity or psychopathological traits, the presence of which may have important implications for the course of the CM and the MO, both for response to treatment and possible relapses. Overuse of symptomatic drugs is regarded as one of the most important risk factor for the transformation of episodic migraine into CM and drug-seeking tendency due to fear of headache in chronic migraine patients shares with obsessive-compulsive disorder (OCD) the compulsive quality of the behavior. Aim of this study was to review the clinical history of a sample of CM patients with MO in which an obsessive-compulsive trait was identified, performing a comparison with a sample of patients without obsessive-compulsive trait. We selected 14 patients with positivity to Spectrum Project OBS (obsessive-compulsive disorder) questionnaire and other 14 patients with negativity to the same tool from among a sample of patients who were enrolled in a previous study on the psychopathological profile of patients suffering from CM with MO. According to data obtained from the clinical records referring to the previous 5 years, patients with OBS questionnaire positivity showed a worse clinical course and a tendency to early relapse in MO after symptomatic medication withdrawal. Our results show that the comorbidity of OCD should be always evaluated in patients with CM and MO as it may play a relevant role--particularly if not treated--among the risk factors favoring the progression of episodic migraine to the chronic form, and/or the tendency to a pathological behavior that prompts the overuse of symptomatic medications.
患有慢性偏头痛 (CM) 和药物过度使用 (MO) 的患者常伴有精神共病或精神病理特征，这些特征可能对 CM 和 MO 的病程产生重要影响，包括对治疗的反应和可能的复发。过度使用对症药物被认为是偏头痛从发作性转变为慢性和药物寻求倾向的最重要危险因素之一，因为慢性偏头痛患者对头痛的恐惧与强迫症 (OCD) 具有相同的强迫行为特征。本研究旨在回顾 MO 伴有强迫特征的 CM 患者的临床病史，并与无强迫特征的患者进行比较。我们从患有 MO 的 CM 患者的先前研究中，选择了 Spectrum Project OBS (强迫症) 问卷阳性的 14 名患者和同一工具阴性的 14 名患者。根据之前 5 年的临床记录数据，OBS 问卷阳性患者在停止对症药物治疗后，MO 的临床病程较差，且早期复发的倾向更大。我们的结果表明，OCD 共病应始终在 CM 和 MO 患者中进行评估，因为它可能是偏头痛从发作性向慢性形式进展的危险因素之一，尤其是在未治疗的情况下，以及/或促使过度使用对症药物的病理性行为的倾向。
