Abstract
Patients with chronic migraine developing medication-overuse headache (MOH) show dependency-like behaviors such as loss of control over analgesics despite adverse consequences on headaches, high rates of relapse after withdrawal from symptomatic medications, and compromised social functioning. Neuroimaging research suggests a common pathophysiology between substance-use disorders and MOH, which involves functional alterations in fronto-striatal networks, particularly in the orbitofrontal region of prefrontal cortex. These findings could explain the impaired decision-making observed in substance-use disorders. We hypothesize that MOH could share fronto-striatal circuit dysfunction and relative decision-making deficit with addiction. We further examine whether this deficit is a persistent cognitive trait or a reversible consequence of medication overuse. This study shows a dataset of 50 patients with MOH before the detoxification. All patients underwent a complete neurological and psychiatric examination. Psychiatric examination consisted of a clinical interview, Structured Clinical Interview for DSM-IV TR Axis II Personality Disorders, Anxiety and Depression Hamilton Scales, Severity of Dependence Scale. The neurological examination included the migraine disability assessment questionnaire. Neuropsychological assessment of fronto-striatal circuits was investigated using the Iowa gambling task (IGT). Twenty patients monitored for any relapse into medication overuse had 12 months of follow-up. Our sample, characterized by high rates of disability and dependency-like behaviors, exhibited a deficit in IGT performance, indicating an overall impairment in decision-making. All the 20 patients showed neurological and psychiatric improvement at 12-month follow-up, notwithstanding the overuse relapse, but a persistent IGT deficit was found. To our knowledge this is the first study that assesses this cognitive function in patients with MOH. Medication-overuse headache seems to share a persistent decision-making deficit with substance abuse that confirms the orbitofrontal cortex hypometabolism described in literature from a neuropsychological perspective. Looking at these shared neurocognitive features, our results suggest that MOH could belong to the addiction spectrum. Fronto-striatal dysfunction could be a premorbid psychobiological condition of vulnerability explaining the clinical onset of medication overuse and recurrent relapses. We propose that IGT could be used to identify chronic migraine patients with higher risk for medication overuse and relapse.
Similar content being viewed by others
Abbreviations
- MOH:
-
Medication-overuse headache
- fMRI:
-
Functional magnetic resonance imaging
- OFC:
-
Orbitofrontal cortex
- PET:
-
Positron emission tomography
- IGT:
-
Iowa gambling task
References
Diener HC, Katsarava Z, Limmroth V (2010) Headache attributed to a substance or its withdrawal. Handb Clin Neurol 97:589–599
Katsarava Z et al (2010) Medication overuse headache: rates and predictors for relapse in a 4-year prospective study. Cephalalgia 25(1):12–15
Calabresi P et al (2005) MOH: similarities with drug addiction. Trends Pharmacol Sci 26(2):62–68
Radat F et al (2010) What is the role of dependence-related behavior in medication-overuse headache? Headache 50(10):1597–1611
Andrasik F, Grazzi L, Usai S, D’Amico D, Kass S, Bussone G (2007) Disability in chronic migraine with medication overuse: treatment effects at 3 years. Headache 47(9):1277–1281
Saper JR, Hamel RL, Lake AE (2005) Medication overuse headache is a bio-behavioral disorder. Cephalalgia 25:545–546
Fuh JL et al (2010) Does medication overuse headache represent a behavior of dependence? Pain 119(1–3):49–55
Volkow ND et al (2004) The addicted human brain viewed in the light of imaging studies: brain circuits and treatment strategies. Neuropharmacology 47(Suppl 1):3–13
Schoenbaum G et al (2008) The role of orbitofrontal cortex in drug addiction: a review of preclinical studies. Biol Psychiatry 63(3):256–262
Crews FT, Boettiger CA (2009) Impulsivity, frontal lobes and risk for addiction. Pharmacol Biochem Behav 93(3):237–247
Dom G et al (2005) Substance use disorders and the orbitofrontal cortex: systematic review of behavioral decision-making and neuroimaging studies. Br J Psychiatry 187:209–220
Paulus MP et al (2003) Decision making by methamphetamine-dependent subjects is associated with error-rate-independent decrease in prefrontal and parietal activation. Biol Psychiatry 53(1):65–74
Bolla KI et al (2003) Orbitofrontal cortex dysfunction in abstinent cocaine abusers performing a decision-making task. Neuroimage 19(3):1085–1094
Fumal A et al (2006) Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine. Brain 129(Pt 2):543–550
Bechara A, Damasio AR, Damasio H, Anderson SW (1994) Insensitivity to future consequences following damage to human prefrontal Cortex. Cognition 50:7–15
Silberstein SD, Olesen J, Bousser MG et al (2005) The International Classification of Headache Disorders, 2nd edition (ICHD-II)—revision of criteria for 8.2 Medication-overuse headache. Cephalalgia 25:460–465
Stewart WF et al (2001) Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology 56(6 Suppl 1):S20–S28
D’Amico D et al (2001) The Migraine Disability Assessment (MIDAS) questionnaire: translation and reliability of the Italian version. Cephalalgia 21(10):947–952
Gossop M et al (1997) Test-retest reliability of the Severity of Dependence Scale. Addiction 92(3):353
Grande RB et al (2009) The Severity of Dependence Scale detects people with medication overuse: the Akershus study of chronic headache. J Neurol Neurosurg Psychiatry 80(7):784–789
Grazzi L et al (2001) Chronic migraine with medication overuse pre-post withdrawal of symptomatic medication: clinical results and fMRI correlations. Headache 50(6):998–1004
Conflict of interest
No current conflicts of interest for any of the authors.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Biagianti, B., Grazzi, L., Gambini, O. et al. Decision-making deficit in chronic migraine patients with medication overuse. Neurol Sci 33 (Suppl 1), 151–155 (2012). https://doi.org/10.1007/s10072-012-1071-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-012-1071-4