Neuropsychological Instruments and Tasks for Dependence Behaviors in Medication-Overuse Headache

This review aims to discuss about the potential roles of neuropsychological instruments and tasks in the evaluation of dependence behaviors shared by medication-overuse headache (MOH) and substance use disorders (SUDs).

Recent studies utilizing criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) for SUDs have revealed that MOH patients often exhibit impaired control over medication use, along with tolerance and withdrawal symptoms. In addition, dependence questionnaires such as the Leeds Dependence Questionnaire and the Severity of Dependence Scale have shown a strong correlation between MOH and higher dependence scores, with predictive value for treatment outcomes. Furthermore, investigations into decision-making processes with the Iowa Gambling Task have suggested potential parallels between MOH and SUDs. MOH patients exhibit biased decision-making, particularly in conditions of ambiguity, possibly predisposing them to favor immediate pain relief over long-term consequences. This suggests a potential mechanism involving emotional feedback processing in MOH. This review underscores the importance of recognizing dependence-like behaviors in MOH patients and highlights the potential utility of neuropsychological instruments and tasks in advancing the understanding of MOH pathophysiology. The findings suggest that MOH shares characteristics with substance dependence, emphasizing the need for tailored interventions in MOH management. Understanding the neurobehavioral aspects of MOH may lead to more effective therapeutic strategies aimed at mitigating dependence and improving long-term outcomes.