Obsessive-compulsive disorder and migraine with medication-overuse headache

Area of Science:

• Neurology
• Psychiatry
• Neuroscience

Background:

• Migraine, especially chronic forms with medication overuse, is linked to depression and anxiety disorders.
• Research on the connection between medication-overuse headache (MOH) and obsessive-compulsive disorder (OCD) is limited.
• Compulsive drug-seeking behavior in MOH shares traits with OCD.

Purpose of the Study:

• To investigate the relationship between obsessive-compulsive disorder (OCD) and medication-overuse headache (MOH) in individuals with migraine.
• To assess the prevalence of psychiatric comorbidities, including OCD, in different migraine subtypes.

Main Methods:

• A structured questionnaire was used to assess episodic migraine (EM), chronic migraine (CM), and MOH patients, alongside control subjects.
• Psychiatric diagnoses were confirmed by a senior psychiatrist blinded to migraine diagnosis.
• The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) evaluated OCD severity.

Main Results:

• Patients with MOH exhibited significantly higher psychiatric comorbidity (anxiety and mood disorders) compared to CM, EM, and controls (P < .0001).
• Subclinical OCD was notably more prevalent in MOH patients than in other groups (P < .0002).
• Both MOH and CM groups showed higher Y-BOCS scores, indicating increased obsessive-compulsive symptom severity, compared to controls and EM.

Conclusions:

• Elevated psychiatric comorbidity in MOH patients may stem from medication overuse or headache chronification.
• A significant rate of subclinical OCD was identified among anxiety disorders in the MOH group.
• OCD may be underdiagnosed and undertreated in MOH patients, warranting further investigation into a direct link with compulsive medication use.