Viticchi Giovanna, Falsetti Lorenzo, Di Felice Chiara, De Vanna Gioacchino, Salvemini Sergio, Bartolini Marco, Moroncini Gianluca, Silvestrini Mauro
Neurological Clinic, Experimental and Clinical Medicine Department, Marche Polytechnic University, 60120 Ancona, Italy.
Clinica Medica, Clinical and Molecular Sciences Department, Marche Polytechnic University, 60120 Ancona, Italy.
Toxins (Basel). 2025 Apr 14;17(4):199. doi: 10.3390/toxins17040199.
Patients with chronic migraine (CM) associated with medication overuse headache (MOH) often exhibit concomitant psychiatric traits including obsessive-compulsive disorder (OCD). Limited data exist on the impact of migraine therapies on these traits. This study aimed to analyse the influence of onabotulinum toxin A (OBT-A) on OCD in CM + MOH patients.
All CM + MOH patients attending the AOU-Marche Headache Centre and treated with OBT-A over a 9-month period were prospectively analysed. At baseline and every three months, patients completed several questionnaires, including the Obsessive-Compulsive Inventory-Revised (OCI-R), to assess the presence of OCD and its subscales.
Thirty patients were enrolled. Repeated measures tests revealed a statistically significant decrease from T0 to T3 in the OCI-R score ( = 0.017) and among the different subscales, specifically the checking score ( = 0.029). The MIDAS (migraine disability assessment score) and HIT-6 (headache impact test) scores exhibited a statistically significant reduction from T0 to T3 ( < 0.0001), similar to the decrease in monthly migraine days and symptomatic medication intake.
Patients treated with OBT-A showed significant improvement in OCD, particularly in subscales assessing somatic and aggressive obsessions as well as control compulsions. Several patients transitioned from a CM + MOH condition to an episodic form without drug abuse. The potential impact of OBT-A on psychiatric symptoms warrants further consideration to improve patient management strategies.
患有与药物过量使用性头痛（MOH）相关的慢性偏头痛（CM）的患者常表现出包括强迫症（OCD）在内的伴随精神特质。关于偏头痛治疗对这些特质的影响的数据有限。本研究旨在分析A型肉毒毒素（OBT - A）对CM + MOH患者强迫症的影响。
对在奥乌 - 马尔凯头痛中心就诊并在9个月期间接受OBT - A治疗的所有CM + MOH患者进行前瞻性分析。在基线时以及每三个月，患者完成几份问卷，包括修订版强迫观念及强迫行为量表（OCI - R），以评估强迫症的存在及其分量表。
共纳入30名患者。重复测量检验显示，从T0到T3，OCI - R评分有统计学显著下降（P = 0.017），在不同分量表中，特别是检查评分（P = 0.029）。偏头痛残疾评估量表（MIDAS）和头痛影响测试（HIT - 6）评分从T0到T3有统计学显著降低（P < 0.0001），类似于每月偏头痛天数和症状性药物摄入量的减少。
接受OBT - A治疗的患者在强迫症方面有显著改善，特别是在评估躯体和攻击性强迫观念以及控制强迫行为的分量表中。几名患者从CM + MOH状态转变为无药物滥用的发作性形式。OBT - A对精神症状的潜在影响值得进一步考虑，以改善患者管理策略。
