[Psychological descriptors of excessive use of analgesic medication]

Patients suffering from migraine and tension-type-headache are at risk of misusing analgesics and therefore developing chronic drug-induced headache. The present study compares migraine patients with and without abuse to identify psychological descriptors promoting drug abuse.

We examined 21 in-patients with migraine and drug-abuse and 21 out-patients with migraine and no drug-abuse who were comparable regarding age and diverse pain variables (intensity, frequency, duration, etc. ). Psychometric questionnaires measured the constructs "pain-", "depression", "self-efficacy" and "pain-coping". Using a standardized interview we investigated the external (environment) and internal (mental factors) conditions of all patients during medication intake.

Migraineurs who misused medications showed significantly greater disability, greater helplessness and anxiety due to pain and a tendency towards more marked general depression than non-abusers. The extent of the helpless and depressive coping with pain was best suited for distinguishing the patients with and without drug abuse, followed by the fact that those with abuse receive drugs from several doctors at the same time and demand that the drugs free them of all complaints.

These findings suggest that migraine patients with drug abuse often take analgesics not according to their headache, but rather depending on certain other factors.