EHMTI-0305. Psychological assessment of patients with chronic refractory headache: a consecutive case series

Background

Refractory headaches (RH) represent a difficult challenge, even for the most skilled practitioners.

Aim

In-depth psychological and psychopathological evaluation of patients with RH.

Methods

We enrolled 51 consecutive patients (age range 24-65 years) with a chronic headache who satisfied 1 or more of the following conditions: 1) failure of at least 2 prophylactic treatments; 2) medication overuse non-responsive to at least 2 properly conducted protocols of detoxification; 3) medication overuse relapsed at least twice after successful detoxification. Patients were evaluated by a clinical psychologist by the means of SCID-I (for psychiatric disorders), SWAP-200 (for personality) and investigation of life/traumatic events.

Results

Ninety-six-percent of the patients showed at least one psychiatric disorders of the anxiety-depression spectrum: 65% at least one anxiety-disorder, 63% at least one mood-disorder and 50% one of somatoform-disorders with 67.65% showing more than one disorder. No patient showed Obsessive-Compulsive disorder or Headache Attributed to Psychiatric disorders (ICHD-III-β). As regards personality clinical characteristics, a relevant portion of subjects showed obsessive personality prototype (43.5%), dysphoric high-functioning personality prototypes was detected in 23% of subjects, while clinical traits of Histrionic and Avoidant personality clinical prototypes were present in 20.6% and 35%, respectively. None of the subjects showed Schizoid, Anti-Social, Emotional Dysregulated, Dependent or Hostile personality prototypes. Forty-seven percent showed some kind of infantile trauma/abuse and 88% referred at least one stressful event after headache onset.

Conclusion

Psychological and psychopathological factors are of critical importance in RH, and should be taken into consideration for both diagnostic and therapeutic purposes.

No conflict of interest.