The peculiar diagnostic approach of migraine in patients with histrionic personality disorders

Abstract

Migraine (M) in patients with hysteria was reported by different authors, but their pathogenetic interaction remains unclear. M diagnosis, due to exclusively subjective criteria, is sometimes difficult to establish in histrionic personality disorders (HPD) associated with conversion disorders (CD) and somatoform disorders (SD). Analysis of clinical features of M in HPD patients and the settlement of specific additional diagnostic support to increase the diagnostic certainty of M. Methods: The study included 31 female patients, average age - 41.8 years, referred to the Headache Center (HC) with a diagnosis of M. The M clinical diagnosis in the HC was based on the International Classification of Headache Disorders criteria (ICHD-2004). The HPD, CD, SD diagnoses were confirmed according to DSM-IV criteria. Additionally, we have practiced discussions with relatives concerning the patients’ verbal and non-verbal behaviour, repeated discussions with patients about M history in different psychological context, and a detailed analysis of medical documentation. All the patients met the criteria of HPD: 12 associated with CD, 19 - with SD. M was present in 25 patients (80.6%), 6 (19.4%) had tension-type headache. Four patients had episodic probable M, 7 - episodic M (3 with aura) and 14 - chronic M (4 with medication overuse). In 6 patients M attacks coincided with CD and SD exacerbation, usually within a psychogenic context. Headache, including migraine, in patients with HPD and other hysterical phenomena, raise diagnostic problems. The use of a larger diagnostic approach, parallel to ICHD-2004, considerably enhances the M diagnostic certainty.