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

Abstract

Background: Refractory headaches (RH) represent a difficult challenge, even for the most skilled practitioners. Aim(s): In-depth psychological and psychopathological evaluation of patients with RH. Method(s): 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. Result(s): Ninety-six-percent of the patients showed at least one psychiatric disorders of the anxiety-depression spectrum: 65% at least one anxietydisorder, 63% at least one mood-disorder and 50% one of somatoformdisorders with 67.65% showing more than one disorder. No patient showed Obsessive-Compulsive disorder or Headache Attributed to Psychiatric disorders (ICHD-III-b). 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(s): Psychological and psychopathological factors are of critical importance in RH, and should be taken into consideration for both diagnostic and therapeutic purposes.