Migraine associated with somatoform disorders - clinical and psychological aspects

Abstract

Introduction: Migraine is a common disorder that imposes a large personal burden on sufferers. According to the World Health Organisation, the prevalence of migraine in 2011 was estimated to be 11%. There is a great number of population-based studies that have reported an association between various psychiatric conditions and migraine. One of these psychiatric conditions is represented by the group of somatoform disorders. The coexistence of comorbid conditions lead to further disability of migraine sufferers in all aspects of their daily lives. Objective: The goal of this study was to determine the céphalalgie, autonomic and psychological particularities of the patients that present migraine in association with somatoform disorders. Methods: This was a case control study involving 32 migraine patients (mean age 44,13±1,39 years), selected during the period of 2011 from the National Neurological and Neurosurgical Institute, Moldova. Migraine was diagnosed using the International Headache Society criteria. Personality traits of the patients were analysed using the Symptom Checklist-90 questionnaire (SCL-90). Somatoform disorders were diagnosed using the DSM-IV TR criteria. In order to evaluate the autonomic disorders, a special questionnaire - The Autonomic Profile (Moldovanu, 2011) was performed. The total number of patients was divided in two groups, group I - the patients who presented a high level of somatoform disorders (12 persons) and group II - the patients who presented a minimal level of somatoform disorders (20 persons). Statistical analysis of data was performed in order to establish the difference between these two group’s findings. Results: The patients from group I showed significantly higher intensity of headache (measured on a 0-10 Numeric Pain Rating Scale) than the patients from group II (7.83±0.39 - 9.42±0.18 vs 4.70±0.34 - 7.15±0.35, p<0.01). Also, the migraine attack duration was different between the groups (6.17±0.74 - 35.00±3.3 hours vs 4.50±0.21 - 11.85±2.84 hours, p<0.01). Talking about psychological findings, the patients from group I showed higher SCL-90 scores than the patients from group II on the following personality traits: obsessive - compulsive (score 0.57±0.07 vs 0.38±0.05), depression (score 1.10±0.14 vs 0.53±0.06) and anxiety (score 1.03±0.09 vs 0.58±0.09) (p<0.01). Regarding the autonomic disorders, they were certainly more expressed in the patients from group I, fact that caused a higher disability score for this group (8.92±0.45 vs 4.35±0.64, p<0.01). Conclusions: There is a high influence of the somatoform disorders, as a comorbidity of migraine, on the céphalalgie, autonomic and psychological particularities of the patients, the final result of this association of diseases causing a significantly higher degree of disability.