P067. Multimodal therapy in the management of MOH: a 3-year experience

Abstract

The relationship between migraine and psychopathology has been clinically discussed in various studies. Medication-overuse headache (MOH) has been often found comorbid with emotional disturbances and disordered personality traits [1,2]. This might play a role in the evolution of migraine to MOH and might be associated with higher risks of chronicization and/or relapses in drug abuse. Psychological disturbances may also be risk factors for a later development of MOH [3]. Since 2012 the Psychology Service of Sant'Andrea Regional Referral Headache Centre has offered short cycles of psychological interviews mostly oriented towards the support of MOH patients during the post-rehabilitation infusional phase in order to prevent relapses. In these past 3 years 106 MOH patients afferent to the Headache Centre underwent the infusional therapy and were eligible for psychological support. Patients' profiles highlighted avoidant and dependent personality traits together with a high level of anxiety and depressive mood. Patients showed a low perception of their personal skill, resources and a perception of their body mostly related to the head pain. The psychological intervention has been cognitive-behavioral and has improved patients' perception of self relative to their body, their personal skills and resources. Psychological support together with prophylaxis therapy with OnabotulinumtoxinA produced in patients a reduction of relapses in drug abuse of 38% compared to a sample of 108 patients age and gender matched that was not eligible for psychological support but received the detoxification and prophylaxis therapy. This means that in some selected cases a multimodal therapy, consisting in a program of pharmacotherapy and psychological support, is necessary for the treatment of MOH patients in order to reduce the risks of relapses into drug abuse