Obsessive-compulsive disorder and migraine with medication-overuse headache.
OBJECTIVE
A strong association has been demonstrated between migraine, particularly in the chronic form and with medication overuse, and either major depression or various anxiety disorders. However, there has been less systematic research on the links between migraine with medication-overuse headache (MOH) and obsessive-compulsive disorder (OCD). A drug-seeking behavior shares with OCD the compulsive quality of the behavior. We investigated the relationship between OCD and MOH in migraineurs.


METHODS
A structured questionnaire was administered to subjects with: episodic migraine (EM) (n = 30), chronic migraine (CM) (n = 24), and MOH with a previous history of EM (n = 33) and 29 control subjects. Psychiatric diagnoses were made by a senior psychiatrist blinded to the diagnosis of migraine. Psychiatric assessment of OCD illness was evaluated by means of The Yale-Brown Obsessive Compulsive Scale (Y-BOCS).


RESULTS
In the subgroup of patients with MOH, psychiatric comorbidity (anxiety and mood disorders) was prevalent compared with CM, EM, and controls (P < .0001). Subclinical OCD was significantly prevalent in MOH patients with respect to other groups (P < .0002). Higher scores in Y-BOCS, as a measure of severity of obsessive-compulsive symptoms, were found in both MOH and CM compared with controls and EM.


CONCLUSIONS
The excess of psychiatric comorbidity in patients with MOH can be related either to medication overuse or to chronification of headache. Among anxiety disorders, we observed a high rate of subclinical OCD. However, a direct link between compulsive behavior and medication overuse cannot be established yet. OCD in MOH might be underdiagnosed and undertreated.
Cupini
Letizia Maria
LM
Ospedale S. Eugenio - Centro Cefalee, UOC Neurologia, P.le dell'Umanesimo 10, Rome 00144, Italy.
De Murtas
Marco
M
Costa
Cinzia
C
Mancini
Maria
M
Eusebi
Paolo
P
Sarchielli
Paola
P
Calabresi
Paolo
P
D000328:Adult; D000700:Analgesics / Q000009:adverse effects; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D006261:Headache / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology*; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology*; D011569:Psychiatric Status Rating Scales; D018709:Statistics, Nonparametric
D000700:Analgesics