Skip to main content
Erschienen in: The Journal of Headache and Pain 1/2013

Open Access 01.12.2013 | Research article

Personality traits in chronic daily headache patients with and without psychiatric comorbidity: an observational study in a tertiary care headache center

verfasst von: Marialuisa Rausa, Sabina Cevoli, Elisa Sancisi, Daniela Grimaldi, Gabriella Pollutri, Michela Casoria, Daniela Grieco, Alberto Bisi, Pietro Cortelli, Euro Pozzi, Giulia Pierangeli

Erschienen in: The Journal of Headache and Pain | Ausgabe 1/2013

Abstract

Background

Previous studies suggest that patients with Chronic Daily Headache (CDH) have higher levels of anxiety and depressive disorders than patients with episodic migraine or tension-type headache. However, no study has considered the presence of psychiatric comorbidity in the analysis of personality traits. The aim of this study is to investigate the prevalence of psychiatric comorbidity and specific personality traits in CDH patients, exploring if specific personality traits are associated to headache itself or to the psychiatric comorbidity associated with headache.

Methods

An observational, cross-sectional study. Ninety-four CDH patients with and without medication overuse were included in the study and assessed by clinical psychiatric interview and Mini International Neuropsychiatric Interview (M.I.N.I.) as diagnostic tools. Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Hamilton Depression Rating Scale (HAM-D) were afterwards administered. Patients with and without psychiatric comorbidity were compared. Further analyses were made by splitting the whole group according to the headache diagnosis and the presence or not of medication overuse.

Results

Psychiatric comorbidity was detected in 44 patients (46.8%) (group A) and was absent in the remaining 50 patients (53.2%) (group B). Mood and anxiety disorders were the most frequently diagnosed (43.6%).
In the overall group, mean scores of MMPI-2 showed a high level in the so-called neurotic triad; in particular the mean score in the Hypochondriasis subscale was in the pathologic area (73.55 ± 13.59), while Depression and Hysteria scores were moderate but not severe (62.53 and 61.61, respectively). In content scales, score in Health Concern was also high (66.73).
Group A presented higher scores compared to Group B in the following MMPI-2 subscales: Hypochondriasis (p = .036), Depression (p = .032), Hysteria (p < .0001), Hypomania (p = .030). Group B had a high score only in the Hypochondriasis subscale. No significant differences were found between chronic migraine (CM)-probable CM (pCM) plus probable medication overuse headache (pMOH) and chronic tension-type headache (CTTH)-probable CTTH (pCTTH) plus pMOH patients or between patients with and without drug overuse.

Conclusions

The so-called “Neurotic Profile” reached clinical level only in CDH patients with psychiatric comorbidity while a high concern about their general health status was a common feature in all CDH patients.
Hinweise

Competing interests

The authors have no conflicts of interest in connection with the submitted article.

Authors’ contributions

MR performed the statistical analysis, was involved in the interpretation of data and was primarily involved in drafting the manuscript. SC made substantial contribution to conception and design of the study, to acquisition and interpretation of data, to critical revision of the manuscript for important intellectual content. ES made substantial contribution the design, in the coordination of the study and in acquisition and analysis of data. DG have been involved in drafting the manuscript and revising it critically. GP made substantial contribution in acquisition of data. MC made substantial contribution in acquisition of data. DG made substantial contribution in acquisition and analysis of data. AB made substantial contribution in acquisition of data. PC made substantial contribution to conception and design of the study. He was involved in the interpretation of data, critical revision of the manuscript for important intellectual content. EP made substantial contribution to conception, design of the study and to interpretation of data. GP contribute to conception of the study and to the acquisition of data. GP made substantial contribution in drafting the manuscript, revising it critically and given final approval of the version to be published. All authors read and approved the final manuscript.
Abkürzungen
CDH
Chronic daily headache
CTTH
Chronic tension-type headache
pCTTH
Probable chronic tension-type headache
CM
Chronic migraine
pCM
Probable chronic migraine
MWOA
Migraine without aura
MWA
Migraine with aura
ETTH
Episodic tension-type headache
MOH
Medication overuse headache
pMOH
Probable medication overuse headache
MMPI-2
Minnesota Multiphasic Personality Inventory
ICHD-II
International classification of headache disorders-II
M.I.N.I
International neuropsychiatric interview
HAM-D
Hamilton depression rating scale

Background

Chronic daily headache (CDH) is not a universally recognized diagnosis but an umbrella term for a group of headache disorders occurring at least 15 days per month [13]. Unfortunately the classification and definition of CDH are still plagued with difficulties [4]. The CDH population comprises individuals with chronic tension-type headache (CTTH) and chronic migraine (CM), both of which may be associated with medication overuse [57]. The majority of patients reporting CDH have a history of episodic headache, mainly migraine without aura (MWOA), evolving into a chronic form over the years [8]. CDH is a major clinical concern and a common health risk, with a prevalence of approximately 3% to 5% in the adult population worldwide [911]. Identifying risk factors for progression has emerged as a major public health priority. Psychiatric comorbidity has been one of the risk factors most widely investigated for headache chronification due the significant role it may play in this process [1216] and because it might be linked to medication overuse in migraineurs [17]. Many epidemiological and clinical studies have confirmed the elevated risk for mood and anxiety disorders in migraine and in CDH [1823]. In particular, patients with CDH showed higher levels of anxiety and depressive disorders than patients with episodic migraine [19]. Some studies [19, 24, 25] hypothesized that patients with medication overuse headache (MOH) may differ psychologically from other headache patients because of a dependence-related behavior, but this hypothesis was not confirmed by more recent findings [2628].
Personality traits assessed by the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) [29] disclosed that patients with CDH showed the so-called “neurotic MMPI-2 profile” characterized by high scores in the first three scales: Hs (Hypochondriasis), D (Depression), and Hy (Hysteria) [30, 31]. A recent study [27] comparing MMPI scores in MOH, episodic headache patients and healthy controls, showed that MOH and episodic headache patients displayed similar patterns, differentiating only in Hypochondriasis scale, and that there were no differences between the three groups in scales measuring dependence-related behavior. Another recent study [28] compared MOH sufferers and drug-addicted patients by means of MMPI-2 dependency scales showing that the two groups did not share personality characteristics linked to dependence. The authors argued that rather than a “true” addiction behavior, a different kind of “dependence” characterized headache patients related to the need to avoid pain. No study has hitherto explored if dependence behaviors in MOH patients are related to the psychiatric comorbidity often associated with CDH.
Aims of the present study were to: 1) investigate the prevalence of psychiatric comorbidity and specific personality traits in CDH patients, 2) investigate if specific personality traits characterize only patients with psychiatric comorbidity or were associated with the headache type.

Methods

One hundred and five consecutive adult patients referred to the Headache Centre of the Department of Neurological Sciences of the University of Bologna and satisfying inclusion criteria for CDH (≥15 days/months for at least 3 months) with or without medication overuse, were recruited by expert neurologists (S.C., E.S., G.P.). Headache and drug overuse were classified according to the original [5] and the revised International Classification of Headache Disorders-II (ICHD-II) criteria [6]. Exclusion criteria were: age <18, secondary CDH assessed by clinical examination, biochemical tests or neuroimaging studies.
The study protocol included a psychiatric evaluation by means of a clinical assessment set up by expert psychiatrists (M.C., D.G., A.B.) and of the Mini International Neuropsychiatric Interview (M.I.N.I.) [32] in order to identify subjects with psychiatric comorbidity. Moreover the Hamilton Depression Rating Scale (HAM-D) [33] and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) [29, 34] questionnaires were administered..
M.I.N.I. [32] is a short structured diagnostic interview for psychiatric disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) [35] and by the International Classification of Diseases, 10th edition (ICD-10) [36]. It generates a positive diagnosis for the main Axis I DSM-IV disorders: mood, anxiety, eating and substance-related disorders. It also explores psychotic symptoms to exclude probable lifetime or current psychotic disorders.
HAM-D [33] is a depression test measuring the severity of clinical depression symptoms. It is a 21-item multiple choice questionnaire assessing depression in four levels: score under 7: no depression, score from 8 to 17: mild depression, score from 18 to 24: moderate depression, score over 25: severe depression.
MMPI-2 [29, 34] is a 567 true-false item questionnaire composed of three validity and ten clinical scales. The questionnaire also includes content scales (clusters of items concerning the same psychological dimension and behavioral area) and supplementary scales which evaluate broad personality traits, generalized emotional distress and behavioral dyscontrol. For each scale, a T-score of 65 was considered as the level of clinical significance in the 95th percentile. MMPI-2 questionnaires were selected on the basis of the three validity scales.
M.I.N.I. and HAM-D were administered by a psychiatrist, while MMPI-2 was self-reported.
The institutional review board of the Department of Neurological Sciences of the University of Bologna approved the study protocol and all participants gave written informed consent. The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

Data analysis

Descriptive statistics (means ± SD) were conducted on the sample features. The sample was divided into two groups according to M.I.N.I. results: patients with and without psychiatric comorbidity (Group A and Group B, respectively). Analysis of skewedness and kurtosis showed that data had a normal distribution. Further analyses were made by splitting the whole group according to the presence or absence of medication overuse, and according to the headache diagnosis: CM or probable CM (pCM) plus probable MOH (pMOH) vs CTTH or probable CTTH (pCTTH) plus pMOH according to the ICDH-II and MOH, CM and CTTH according to the ICDH-II revised criteria. Moreover we consider which preventive therapy patients were assuming.
Chi-squared and Student’s T-test were performed to compare data between groups. Data were analyzed using the statistical software SPSS 19.0 (Statistical Package for Social Science). Significance level was set at p < .05.

Results

Descriptive analysis

Ninety-four out of 105 patients with CDH and consecutively referred to the Headache Center were recruited. Eleven refused to participate in the study, 94 accepted to partecipate and signed an informed consent. All partecipating patients received a psychiatric evaluation by means of a clinical assessment and of the M.I.N.I. [32]. Seven patients withdrew their consent. To the 87 patients left, the HAM-D [33] and the MMPI-2 [29, 34] questionnaires were administered.
According to the original ICHD-II criteria [5], four subjects (4.2%) had a diagnosis of CM, 18 ( 19.1%) of CTTH, 43 (45.7%) had a diagnosis of pCM plus pMOH, and 29 (30.9%) of pCTTH plus pMOH. According to ICHD-II revised criteria [6], four subjects (4.2%) had a diagnosis of CM, 18 (19.2%) of CTTH, and 72 (76.6%) of MOH.
Table 1 shows patients’ demographic and headache features. Drug overuse was significantly higher in pCM + pMOH patients compared to pCTTH + pMOH patients (43 vs 29, χ2 = 11.631; p < .001).
Table 1
Patients’ demographic and headache characteristics
Gender
 
Male, n (%)
22 (23.4)
Female, n (%)
72 (76.6)
Age (yrs), mean ± sd (min-max)
48.51 ±14.31 (19-75)
Educational level
n (%)
Elementary/secondary school,
50 (53,2)
High or graduate school, n (%)
44 (44.7)
Types of headache at onset
n (%)
MWOA
78 (83.0)
MWOA + MWA
8 (8.5)
ETTH
5 (5.3)
CTTH
3 (3.2)
Age of chronification (yrs), mean ± sd
38.10 ±14.95
Duration of chronification (yrs), mean ± sd
10.21 ± 10.63
Type of CDH
n (%)
(Revised ICHD-II diagnosis)
MOH 72 (76.6)
CTTH 18 (19.2)
CM 4 (4.2)
Type of CDH
n (%)
(ICDH-II diagnosis)
CM 4 (4,2%)
pCM, pMOH 43 (45,7%)
CTTH 18 (19.2%)
pCTTH, pMOH 29 (30.8%)
CTTH = chronic tension-type headache; ETTH = episodic tension-type headache; MWA = migraine with aura; MWOA = migraine without aura; MOH = medication overuse headache, CM = chronic migraine, pCM = probable CM, pCTTH = probable CTTH, pMOH = probable MOH.

Psychiatric comorbidity

Descriptive analysis of M.I.N.I. showed that 44 patients (46.8%) presented psychiatric comorbidity (group A), whereas 50 patients (53.2%) did not present any psychiatric comorbidity (group B) (Table 2). In particular, within group A, 20 patients (21.2%) were classified as mood disorder sufferers, 16 patients (17%) had an anxiety disorder, six patients (6.4%) had anxiety and mood disorder and two patients (2.1%) had other psychiatric disorders (eating disorders).
Table 2
Psychiatric comorbidity
 
Group A
Group B
Total
Mood disorder
Anxiety disorder
Mood and anxiety disorder
Other psychological disorder
  
CM
1 (1.1%)
0 (0%)
0 (0%)
0 (0%)
3 (2.1%)
4 (4.2%)
pCM plus pMOH
8 (8.5%)
7 (7.4%)
2 (2.1%)
1 (1.1%)
25 (26.6%)
43 (45.7%)
CTTH
4 (4.2%)
1 (1.1%)
3 (3.1%)
0 (0%)
10 (10.6%)
18 (19.1%)
pCTTH plus pMOH
7 (7.4%)
8 (8.5%)
1 (1.1%)
1 (1.1%)
12 (12.8%)
29 (30.8%)
Total
20 (20.2%)
16 (17.0%)
6 (6.4%)
2 (2.1%)
50 (53.2%)
94 (100%)
CM = Chronic migraine, pCM = probable chronic migraine, pMOH = probable medication overuse headache, CTTH = chronic tension-type headache, pCTTH = probable chronic tension-type headache (according to the original ICHD-II criteria). Group A = patients with psychiatric comorbidity Group B = patients without psychiatric comorbidity.
No significant differences in psychiatric comorbidity frequency were found between CM or pCM plus pMOH and CTTH or pCTTH plus pMOH patients (p = .219), or between patients with and without drug overuse (p = .534). No significant differences were found in the percentage of Group A and Group B patients assuming antidepressant or mood stabilizer as preventive therapies (10/44 Group A and 16/50 Group B, χ2 = 0.596; p = .440).

MMPI-2

Among the 94 patients, only 87 correctly completed the questionnaire, and 4 questionnaires were excluded because they did not achieve validity’s level described in the MMPI-2 manual. Statistical analyses were made in the 10 clinical scales. In the overall group, mean scores of MMPI-2 showed a high level in the so-called neurotic triad. In particular the mean score in the Hypochondriasis subscale was in the pathologic area (73.55 ± 13.59), while Depression and Hysteria scores were moderate but not severe (62, 53 and 61.61, respectively). Secondary analyses were made on content and supplementary MMPI-2 scales. In content scales, score in Health Concern was also high (66.73).
Group A showed significantly higher scores in the following MMPI-2 subscales when compared to Group B (Table 3): Hypochondriasis (p = .031), Depression (p = .008), Hysteria (p < .0001), Psychopatic Deviate (p = .025), Psychasthenia (p = .0,19), Schizophrenia p = .017), Hypomania (p = .025). Group B had a high score only in the Hypochondriasis subscale (70.38 ± 12.78).
Table 3
Mean and standard deviation ( Mean±sd) of MMPI-2 scores*
  
Total N = 74
Group A N = 39
Group B N = 35
P
MMPI
Hs (Hypochondriasis)
73.55 (13.60)
76.80 (13.79)
70.38 (12.78)
*0.03
Clinical Scales
D (Depression)
62.53 (12.61)
66.19 (12.49)
58,95 (11.81)
*0.00
 
Hy (Hysteria)
61.61 (13.36)
66.78 (12.93)
56.57 (11.87)
*0.00
 
Pd (Psychopathic Deviate)
53.85 (10.27)
56.39 (9,08)
51.38 (10.85)
*0.02
 
Mf (Masculinity-feminility)
46.99 (9.85)
47.76 (8.48)
46.23 (11.09)
*0.49
 
Pa (Paranoia)
55.49 (10.82)
56.63 (9.56)
54.38 (11.93)
*0.35
 
Pt (Psychasthenia)
57.47 (10.78)
60.27 (10.61)
56.74 (10.34)
*0.02
 
Sc (Schizophrenia)
55.75 (10.11)
58.41 (9.98)
53.14 (9.65)
*0.02
 
Ma (Hypomania)
46.62 (11.36)
49.44 (10.87)
43.88 (11.29)
*0.02
 
Si (Social introversion)
57.79 (10.94)
59.90 (10.56)
55.74 (11.03)
*0.08
*T-scores > 65 (considered to be the level of clinical significance) are in bold. Group A = patients with psychiatric comorbidity; Group B = patients without psychiatric comorbidity. Hyp + Dep + Hys = ”Neurotic profile”. * p < .05.
In the content scales, group A had high score in Health Concern (Group A = 69,24, Group B = 64,29; p > .05). The two groups did not show any high score in content scales, but differentiated in: Anxiety (Group A = 61,95, Group B = 57,40; p = .047), Depression (Group A = 60,76, Group B = 55,50; p = .025), Family Problems (Group A = 59,29, Group B = 54,40; p = .046); Work Interference (Group A = 58,56, Group B = 52,67; p = .021).
In the supplementary scales no high scores were found, but the two groups also differentiated in: Anxiety (Group A = 62,51, Group B = 56,60; p = .026) College Maladjustment (Group A = 64,95, Group B = 59,45; p = .026), Gender Feminine (Group A = 50,12, Group B = 44,57; p = .009), Post-Traumatic Stress disorder (Group A = 60,14, Group B = 54,88; p = .022); Addiction Potential Scale (Group A = 49.02, Group B = 43,38; p = .008).
No significant differences were found between CM or pCM plus pMOH and CTTH or pCTTH plus pMOH patients or between patients with and without drug overuse (Table 4).
Table 4
Mean and standard deviation ( Mean ± sd) of MMPI-2 scores in CM-pCM + pMOH versus CTTH-p CTTH + pMOH and MOH versus NO MOH
 
CM and pCM + pMOH
CTTH and pCTTH + pMOH
p
MOH
NO MOH
p
N = 42
N = 45
N = 66
N = 21
Hs (Hypochondriasis)
75.21 (11.66)
71.35 (14.82)
0.17
73.96 (13.07)
70.85 (14.64)
0.39
D (Depression)
63.90 (9.88)
60.37 (14.56)
0.18
63.57 (11.48)
57.38 (14.88)
0.09
Hy (Hysteria)
62.85 (10.28)
59.66 (15.39)
0.26
62.22 (12.97)
58.00 (13.70)
0.22
Pd (Psychopathic Deviate)
54.90 (9.82)
52.11 (9.82)
0.22
54.36 (9.82)
50.61 (12.26)
0.21
Mf (Masculinity-feminility)
47.90 (9.69)
47.04 (10.31)
0.69
47.68 (9.52)
46.76 (11.48)
0.74
Pa (Paranoia)
56.69 (9.93)
54.40 (12.12)
0.34
56.53 (10.35)
52.28 (12.97)
0.18
Pt (Psychasthenia)
58.02 (10.63)
56.13 (10.92)
0.42
57.04 (10.68)
57.04 (11.25)
0.99
Sc (Schizophrenia)
55.38 (10.05)
55.53 (10.36)
0.94
55.72 (10.15)
54.61 (10.35)
0.67
Ma (Hypomania)
47.92 (10.20)
45.60 (12.12)
0.33
46.75 (10.60)
46.61 (13.33)
0.96
Si (Social introversion)
57.76 (10.20)
57.51 (11.34)
0.91
58.22 (9.67)
55.76 (13.70)
0.45
T-scores > 65 (considered to be the level of clinical significance) are in bold. CM = Chronic migraine, pCM = probable chronic migraine, pMOH = probable medication overuse headache, CTTH = chronic tension-type headache, pCTTH = probable chronic tension-type headache (according to the original ICHD-II criteria).

HAM-D

We analyzed 87 valid questionnaires. The mean value of the total sample at Hamilton Depression Scale was 6.4 and it remained in the normative range indicative for absence of depression. Group A (n = 43) had a scale mean value indicative for the presence of mild depression (9.47 ± 4.26), significantly higher than group B (n = 42; 3.48 ± 3.24) (t = 7.37, p < .0001). No significant differences were found between CM or pCM plus pMOH and CTTH or pCTTH plus pMOH patients (p = .345) or between patients with and without drug overuse (p = .994).

Discussion

Our study evaluated the prevalence of psychiatric comorbidity and specific personality traits in CDH patients. Headache and drug overuse were classified using both the original [5] and the revised International Classification of Headache Disorders-II (ICHD-II) [6] criteria to clearly differentiate the type of prevalent headache (migraine vs tension-type headache) and the presence of drug overuse.
In our sample drug overuse is significantly increased in pCM + pMOH patients with respect to pCTTH + pMOH patients, probably due to the pain severity of their attacks.
Of the 94 subjects included in the sample, 46.8% showed psychiatric comorbidity. The disorders most frequently diagnosed were mood and anxiety disorders (43.6%). These data are in line with some previous literature [26, 3739], indicating that the most common psychiatric conditions related to migraine were depression, bipolar disorders, anxiety [19] and somatoform disorders. However, the relationship between CDH and psychiatric disorders is still matter of debate in the literature, this being also due to the different headache diagnostic criteria and the different methods adopted in most of the studies to assess psychiatric disorders [1216]. Verri and colleagues [21] found an association between CDH and at least one psychiatric disorder in 90% of their patients. Juang and colleagues [22] found that the frequency of any type of anxiety disorder was significantly higher in patients with CM than in those with CTTH. This was not confirmed in our sample in which no differences were found in psychiatric comorbidity between the migraine and the tension-type headache groups, and between patients with and without drug overuse. These findings are in agreement with the results obtained by Atasoy and colleagues [40] who analyzed psychiatric comorbidity in 89 MOH patients and did not find any difference in MOH patients with pre-existing episodic tension-type headache (ETTH) with respect to those with pre-existing MWOA.
Psychiatric comorbidity has often been clinically discussed rather than systematically studied. The use of M.I.N.I., a structured clinical psychiatric interview [41], helped us to establish a diagnosis on reliable and valid diagnostic criteria. Although M.I.N.I. is considered a somewhat overinclusive instrument in ‘making diagnosis’ [42], it indicated the presence of depression in our sample, while HAM-D results revealed that the mood disorder was milder than expected. Moreover, after clinical interviews, psychiatrists reported that psychiatric disorders in MOH appear in subthreshold forms rather than as full-blown disorders. Even if the percentage of patients assuming prophylactic therapies with antidepressant or mood stabilizer drugs was similar in both groups, with and without psychiatric comorbidity, we can not exclude a role of these drugs in the final results.
Previous MMPI-2 results stressed the presence of the “neurotic MMPI-2 profile” in headache patients, a profile characterized by a high level of depression, hypochondria and hysteria [27, 30, 31]. We found that in our sample, the neurotic triad was detected only in patients with psychiatric comorbidity, while patients without psychiatric comorbidity displayed a high score only in the Hypochondriasis subscale, indicating high concern for their health status. The presence of the “neurotic MMPI-2 profile” in chronic headache has already been the focus of previous studies [27, 28] arguing that these personality traits appeared to be a reaction to chronic pain rather than a specific feature of headache patients [43]. Our results suggest for the first time that the “neurotic MMPI-2 profile” was not associated to headache per se, but was a dominant feature in headache patients who showed comorbidity with psychiatric disorders. However the cross-sectional design of the study does not permit to reveal any casual relationship.
The two groups also differentiated for scores in Addiction Potential Scale: patients with psychiatric comorbidity had higher scores than patients without, even if the scores fell in the normal range. Furthermore, the presence of medication overuse was not a discriminating factor. These data support Galli et al.’s [28] hypothesis that medication overuse in CDH patients might not be related to dependence, but rather might be a consequence of chronic pain. From this perspective, medication overuse could be seen as the only way patients know to cope with their pain and maintain a normal lifestyle. However, this hypothesis conflicts with other studies on dependence in patients with MOH [25]. Specific instruments are needed to assess dependence behavior in MOH patients as it seems to have different theoretical constructs from classic dependence behavior [27].
A high score in MMPI-2 Health Concern subscale was found in all CDH patients suggesting concern for their general health condition, and not only for their headache. This result is concordant with the elevated score also found in the Hypochondria clinical scale.
We acknowledge the limitations of the present study, the principal one being that it was performed in a tertiary care headache clinic so that the investigated sample may not represent the whole spectrum of CDH patients in the general population. Another limitation was that MMPI-2 was properly completed only by 83 of the 94 subjects included. Another major problem was the diagnostic distinction of CDH and drug overuse that remains controversial and could introduce a selection bias. We tried however to overcome this limitation, which is intrinsic to all studies investigating headache chronification, by applying the IHS revised criteria for headache diagnosis.

Conclusion

Our study showed that the so-called Neurotic Profile (high level of hypochondria, depression and hysteria) reached a clinical level only in patients with psychiatric comorbidity and that all CDH patients, independently from psychiatric comorbidity, had a high score in hypochondria evaluation suggesting a high concern for their general health status. Large population-based studies are needed to confirm this original finding and future prospective studies might also evaluate how hypocondria is a risk factor for transformation from episodic to chronic headache and if it is possible to modify this aspect by applying cognitive behavioral interventions.

Acknowledgment

With profound sadness we thank Prof. Pasquale Montagna, our peerless mentor, great friend, outstanding scientist, physician and man.
This work was partially supported by a research grant from the Isabella Seragnoli Foundation awarded to Marialuisa Rausa.
Open Access This article is distributed under the terms of the Creative Commons Attribution 2.0 International License ( https://​creativecommons.​org/​licenses/​by/​2.​0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Competing interests

The authors have no conflicts of interest in connection with the submitted article.

Authors’ contributions

MR performed the statistical analysis, was involved in the interpretation of data and was primarily involved in drafting the manuscript. SC made substantial contribution to conception and design of the study, to acquisition and interpretation of data, to critical revision of the manuscript for important intellectual content. ES made substantial contribution the design, in the coordination of the study and in acquisition and analysis of data. DG have been involved in drafting the manuscript and revising it critically. GP made substantial contribution in acquisition of data. MC made substantial contribution in acquisition of data. DG made substantial contribution in acquisition and analysis of data. AB made substantial contribution in acquisition of data. PC made substantial contribution to conception and design of the study. He was involved in the interpretation of data, critical revision of the manuscript for important intellectual content. EP made substantial contribution to conception, design of the study and to interpretation of data. GP contribute to conception of the study and to the acquisition of data. GP made substantial contribution in drafting the manuscript, revising it critically and given final approval of the version to be published. All authors read and approved the final manuscript.
Literatur
1.
Zurück zum Zitat Halker RB, Hastriter EV, Dodick DW: Chronic daily headache: an evidence-based and systematic approach to a challenging problem. Neurology 2011,76(2):S37–43.PubMedCrossRef Halker RB, Hastriter EV, Dodick DW: Chronic daily headache: an evidence-based and systematic approach to a challenging problem. Neurology 2011,76(2):S37–43.PubMedCrossRef
2.
Zurück zum Zitat Scher AI, Stewart WF, Liberman J, Lipton RB: Prevalence of frequent headache in a population sample. Headache 1998, 38: 497–506. 10.1046/j.1526-4610.1998.3807497.xPubMedCrossRef Scher AI, Stewart WF, Liberman J, Lipton RB: Prevalence of frequent headache in a population sample. Headache 1998, 38: 497–506. 10.1046/j.1526-4610.1998.3807497.xPubMedCrossRef
3.
Zurück zum Zitat Castillo J, Munoz J, Guitera V, Pascual J: Kaplan Award 1998. Epidemiology of chronic daily headache in the general population. Headache 1999, 39: 190–196. 10.1046/j.1526-4610.1999.3903190.xPubMedCrossRef Castillo J, Munoz J, Guitera V, Pascual J: Kaplan Award 1998. Epidemiology of chronic daily headache in the general population. Headache 1999, 39: 190–196. 10.1046/j.1526-4610.1999.3903190.xPubMedCrossRef
4.
Zurück zum Zitat Manzoni GC, Bonavita V, Bussone G, Cortelli P, Narbone MC, Cevoli S, D’Amico D, De Simone R, Torelli P: Chronic migraine classification: current knowledge and future perspectives. J Headache Pain 2011, 12: 585–592. 10.1007/s10194-011-0393-6PubMedCentralPubMedCrossRef Manzoni GC, Bonavita V, Bussone G, Cortelli P, Narbone MC, Cevoli S, D’Amico D, De Simone R, Torelli P: Chronic migraine classification: current knowledge and future perspectives. J Headache Pain 2011, 12: 585–592. 10.1007/s10194-011-0393-6PubMedCentralPubMedCrossRef
5.
Zurück zum Zitat Headache Classification Committee of the International Headache Society: The International Classification of Headache Disorders, 2nd edition. Cephalalgia 2004,24(Suppl 1):9–160. Headache Classification Committee of the International Headache Society: The International Classification of Headache Disorders, 2nd edition. Cephalalgia 2004,24(Suppl 1):9–160.
6.
Zurück zum Zitat Olesen J, Bousser M-G, Diener H-C: Headache Classification Committee. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia 2006, 26: 742–746.PubMedCrossRef Olesen J, Bousser M-G, Diener H-C: Headache Classification Committee. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia 2006, 26: 742–746.PubMedCrossRef
7.
Zurück zum Zitat Sancisi E, Cevoli S, Pierangeli G: Application of ICHD-II and revised diagnostic criteria to patients with chronic daily headache. Neurol Sci 2007, 28: 2–8. 10.1007/s10072-007-0741-0PubMedCrossRef Sancisi E, Cevoli S, Pierangeli G: Application of ICHD-II and revised diagnostic criteria to patients with chronic daily headache. Neurol Sci 2007, 28: 2–8. 10.1007/s10072-007-0741-0PubMedCrossRef
8.
Zurück zum Zitat Mathew NT, Stubits E, Nigam MR: Transformation of episodic migraine into daily headache: Analysis of factors. Headache 1982, 22: 66–68. 10.1111/j.1526-4610.1982.hed2202066.xPubMedCrossRef Mathew NT, Stubits E, Nigam MR: Transformation of episodic migraine into daily headache: Analysis of factors. Headache 1982, 22: 66–68. 10.1111/j.1526-4610.1982.hed2202066.xPubMedCrossRef
9.
Zurück zum Zitat Colas R, Munoz P, Temprano R, Gomez SW, Pascual J: Chronic daily headache with drug analgesic overuse. Epidemiology and impact on quality of life. Neurology 2004, 62: 1338–1342. 10.1212/01.WNL.0000120545.45443.93PubMedCrossRef Colas R, Munoz P, Temprano R, Gomez SW, Pascual J: Chronic daily headache with drug analgesic overuse. Epidemiology and impact on quality of life. Neurology 2004, 62: 1338–1342. 10.1212/01.WNL.0000120545.45443.93PubMedCrossRef
10.
Zurück zum Zitat Diener HC, Limmroth V: Medication-overuse headache: A worldwide problem. Lancet Neurol 2004, 3: 475–483. 10.1016/S1474-4422(04)00824-5PubMedCrossRef Diener HC, Limmroth V: Medication-overuse headache: A worldwide problem. Lancet Neurol 2004, 3: 475–483. 10.1016/S1474-4422(04)00824-5PubMedCrossRef
11.
Zurück zum Zitat Jonsson P, Hedenrud T, Linde M: Epidemiology of medication overuse headache in the general Swedish population. Cephalalgia 2011, 31: 1015–22. 10.1177/0333102411410082PubMedCrossRef Jonsson P, Hedenrud T, Linde M: Epidemiology of medication overuse headache in the general Swedish population. Cephalalgia 2011, 31: 1015–22. 10.1177/0333102411410082PubMedCrossRef
12.
Zurück zum Zitat Guidetti V, Galli F, Fabrizi P: Headache and psychiatric comorbidity: Clinical aspects and outcome in an 8-year follow-up study. Cephalalgia 1998, 18: 455–462. 10.1046/j.1468-2982.1998.1807455.xPubMedCrossRef Guidetti V, Galli F, Fabrizi P: Headache and psychiatric comorbidity: Clinical aspects and outcome in an 8-year follow-up study. Cephalalgia 1998, 18: 455–462. 10.1046/j.1468-2982.1998.1807455.xPubMedCrossRef
13.
Zurück zum Zitat Pompili M, Serafini G, Di Cosimo D, Dominici G, Innamorati M, Lester D, Forte A, Girardi N, De Filippis S, Tatarelli R, Martelletti P: Psychiatric comorbidity and suicide risk in patients with chronic migraine. Neuropsychiatr Dis Treat 2010, 6: 81–91.PubMedCentralPubMedCrossRef Pompili M, Serafini G, Di Cosimo D, Dominici G, Innamorati M, Lester D, Forte A, Girardi N, De Filippis S, Tatarelli R, Martelletti P: Psychiatric comorbidity and suicide risk in patients with chronic migraine. Neuropsychiatr Dis Treat 2010, 6: 81–91.PubMedCentralPubMedCrossRef
14.
Zurück zum Zitat Buse DC, Silberstein SD, Manack AN, Papapetropoulos S, Lipton RB: Psychiatric comorbidities of episodic and chronic migraine. J Neurol 2012. Buse DC, Silberstein SD, Manack AN, Papapetropoulos S, Lipton RB: Psychiatric comorbidities of episodic and chronic migraine. J Neurol 2012.
15.
Zurück zum Zitat Heckman BD, Merrill JC, Anderson T: Race, psychiatric comorbidity, and headache characteristics in patients in headache subspecialty treatment clinics. Ethn Health 2012. Heckman BD, Merrill JC, Anderson T: Race, psychiatric comorbidity, and headache characteristics in patients in headache subspecialty treatment clinics. Ethn Health 2012.
16.
Zurück zum Zitat Serafini G, Pompili M, Innamorati M, Negro A, Fiorillo M, Lamis DA, Erbuto D, Marsibilio F, Romano A, Amore M, D’Alonzo L, Bozzao A, Girardi P, Martelletti P: White matter hyperintensities and self-reported depression in a sample of patients with chronic headache. J Headache Pain 2012, 13: 661–667. 10.1007/s10194-012-0493-yPubMedCentralPubMedCrossRef Serafini G, Pompili M, Innamorati M, Negro A, Fiorillo M, Lamis DA, Erbuto D, Marsibilio F, Romano A, Amore M, D’Alonzo L, Bozzao A, Girardi P, Martelletti P: White matter hyperintensities and self-reported depression in a sample of patients with chronic headache. J Headache Pain 2012, 13: 661–667. 10.1007/s10194-012-0493-yPubMedCentralPubMedCrossRef
17.
Zurück zum Zitat Radat F, Sakh D, Lutz G, El Amrani M, Ferreri M, Bousser MG: Psychiatric comorbidity is related to headache induced by chronic substance use in migraineurs. Headache 1999, 39: 477–480. 10.1046/j.1526-4610.1999.3907477.xPubMedCrossRef Radat F, Sakh D, Lutz G, El Amrani M, Ferreri M, Bousser MG: Psychiatric comorbidity is related to headache induced by chronic substance use in migraineurs. Headache 1999, 39: 477–480. 10.1046/j.1526-4610.1999.3907477.xPubMedCrossRef
18.
Zurück zum Zitat Radat F, Swendsen J: Psychiatric comorbidity in migraine: a review. Cephalalgia 2005, 25: 165–178. 10.1111/j.1468-2982.2004.00839.xPubMedCrossRef Radat F, Swendsen J: Psychiatric comorbidity in migraine: a review. Cephalalgia 2005, 25: 165–178. 10.1111/j.1468-2982.2004.00839.xPubMedCrossRef
19.
Zurück zum Zitat Radat F, Creac’h C, Swendsen JD: Psychiatric comorbidity in the evolution from migraine to medication overuse headache. Cephalalgia 2005, 25: 519–522. 10.1111/j.1468-2982.2005.00910.xPubMedCrossRef Radat F, Creac’h C, Swendsen JD: Psychiatric comorbidity in the evolution from migraine to medication overuse headache. Cephalalgia 2005, 25: 519–522. 10.1111/j.1468-2982.2005.00910.xPubMedCrossRef
20.
Zurück zum Zitat Baskin SM, Lipchik GL, Smitherman TA: Mood and anxiety disorders in chronic headache. Headache 2006,46(suppl 3):S76-S87.PubMedCrossRef Baskin SM, Lipchik GL, Smitherman TA: Mood and anxiety disorders in chronic headache. Headache 2006,46(suppl 3):S76-S87.PubMedCrossRef
21.
Zurück zum Zitat Verri AP, Proietti Cecchini A, Galli C, Granella F, Mandrini G, Nappi G: Psychiatric comorbidity in chronic daily headache. Cephalalgia 1998,18(suppl 21):45–49.PubMed Verri AP, Proietti Cecchini A, Galli C, Granella F, Mandrini G, Nappi G: Psychiatric comorbidity in chronic daily headache. Cephalalgia 1998,18(suppl 21):45–49.PubMed
22.
Zurück zum Zitat Juang K-D, Wang S-J, Fuh J-L, Lu S-R, Su T-P: Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes. Headache 2000, 40: 818–823. 10.1046/j.1526-4610.2000.00148.xPubMedCrossRef Juang K-D, Wang S-J, Fuh J-L, Lu S-R, Su T-P: Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes. Headache 2000, 40: 818–823. 10.1046/j.1526-4610.2000.00148.xPubMedCrossRef
23.
Zurück zum Zitat Pompili M, Di Cosimo D, Innamorati M, Lester D, Tatarelli R, Martelletti P: Psychiatric comorbidity in patients with chronic daily headache and migraine: a selective overview including personality traits and suicide risk. J Headache Pain 2009,10(4):283–90. 10.1007/s10194-009-0134-2PubMedCentralPubMedCrossRef Pompili M, Di Cosimo D, Innamorati M, Lester D, Tatarelli R, Martelletti P: Psychiatric comorbidity in patients with chronic daily headache and migraine: a selective overview including personality traits and suicide risk. J Headache Pain 2009,10(4):283–90. 10.1007/s10194-009-0134-2PubMedCentralPubMedCrossRef
24.
Zurück zum Zitat Saper JR, Hamel RL, Lake AE 3rd: Medication overuse headache (MOH) is a biobehavioural disorder. Cephalalgia 2005, 25: 545–546. 10.1111/j.1468-2982.2005.00879.xPubMedCrossRef Saper JR, Hamel RL, Lake AE 3rd: Medication overuse headache (MOH) is a biobehavioural disorder. Cephalalgia 2005, 25: 545–546. 10.1111/j.1468-2982.2005.00879.xPubMedCrossRef
25.
Zurück zum Zitat Fuh JL, Wang SJ, Lu SR, Juang KD: Does medication overuse headache represent a behavior of dependence? Pain 2005, 119: 49–55. 10.1016/j.pain.2005.09.034PubMedCrossRef Fuh JL, Wang SJ, Lu SR, Juang KD: Does medication overuse headache represent a behavior of dependence? Pain 2005, 119: 49–55. 10.1016/j.pain.2005.09.034PubMedCrossRef
26.
Zurück zum Zitat Antonaci F, Nappi G, Galli F, Manzoni GC, Calabresi P, Costa A: Migraine and psychiatric comorbidity: a review of clinical findings. J Headache Pain 2011,12(2):115–25. 10.1007/s10194-010-0282-4PubMedCentralPubMedCrossRef Antonaci F, Nappi G, Galli F, Manzoni GC, Calabresi P, Costa A: Migraine and psychiatric comorbidity: a review of clinical findings. J Headache Pain 2011,12(2):115–25. 10.1007/s10194-010-0282-4PubMedCentralPubMedCrossRef
27.
Zurück zum Zitat Sances G, Galli F, Anastasi S, Ghiotto N, De Giorgio G, Guidetti V, Firenze C, Pazzi S, Quartesan R, Gallucci M, Nappi G: Medication-overuse headache and personality: a controlled study by means of the MMPI-2. Headache 2010,50(2):198–209. 10.1111/j.1526-4610.2009.01593.xPubMedCrossRef Sances G, Galli F, Anastasi S, Ghiotto N, De Giorgio G, Guidetti V, Firenze C, Pazzi S, Quartesan R, Gallucci M, Nappi G: Medication-overuse headache and personality: a controlled study by means of the MMPI-2. Headache 2010,50(2):198–209. 10.1111/j.1526-4610.2009.01593.xPubMedCrossRef
28.
Zurück zum Zitat Galli F, Pozzi G, Frustaci A, Allena M, Anastasi S, Chirumbolo A, Ghiotto N, Guidetti V, Matarrese A, Nappi G, Pazzi S, Quartesan R, Sances G, Tassorelli C: Differences in the personalty profile of medication overuse headache sufferers and drug addict patients: a comparative study using MMPI-2. Headache 2011,51(8):1212–1227. 10.1111/j.1526-4610.2011.01978.xPubMedCrossRef Galli F, Pozzi G, Frustaci A, Allena M, Anastasi S, Chirumbolo A, Ghiotto N, Guidetti V, Matarrese A, Nappi G, Pazzi S, Quartesan R, Sances G, Tassorelli C: Differences in the personalty profile of medication overuse headache sufferers and drug addict patients: a comparative study using MMPI-2. Headache 2011,51(8):1212–1227. 10.1111/j.1526-4610.2011.01978.xPubMedCrossRef
29.
Zurück zum Zitat Butcher JN, Dahlstrom WG, Graham JR, Tellegen A, Kaemmer B: The Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for administration and scoring. Minneapolis, MN: University of Minnesota Press; 1989. Butcher JN, Dahlstrom WG, Graham JR, Tellegen A, Kaemmer B: The Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for administration and scoring. Minneapolis, MN: University of Minnesota Press; 1989.
30.
Zurück zum Zitat Bigal ME, Sheftell FD, Rapaport AM, Tepper SJ, Weeks R, Baskin SM: MMPI personality profiles in patients with primary chronic headache: A case-control study. Neurol Sci 2003,24(3):103–10. 10.1007/s10072-003-0094-2PubMedCrossRef Bigal ME, Sheftell FD, Rapaport AM, Tepper SJ, Weeks R, Baskin SM: MMPI personality profiles in patients with primary chronic headache: A case-control study. Neurol Sci 2003,24(3):103–10. 10.1007/s10072-003-0094-2PubMedCrossRef
31.
Zurück zum Zitat Mongini F, Defilippi N, Negro C: Chronic daily headache. A clinical and psychological profile before and after the treatment. Headache 1997, 37: 83–87. 10.1046/j.1526-4610.1997.3702083.xPubMedCrossRef Mongini F, Defilippi N, Negro C: Chronic daily headache. A clinical and psychological profile before and after the treatment. Headache 1997, 37: 83–87. 10.1046/j.1526-4610.1997.3702083.xPubMedCrossRef
32.
Zurück zum Zitat Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini.-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998,59(20):22–33.PubMed Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini.-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998,59(20):22–33.PubMed
33.
Zurück zum Zitat Hamilton M: A rating scale for depression. Journal of Neurolog Neurosurg Psychiatry 1960, 23: 56–62. 10.1136/jnnp.23.1.56CrossRef Hamilton M: A rating scale for depression. Journal of Neurolog Neurosurg Psychiatry 1960, 23: 56–62. 10.1136/jnnp.23.1.56CrossRef
34.
Zurück zum Zitat Pancheri P, Sirigatti S: MMPI-2 (Adattamento Italiano). Firenze: Organizzazioni Speciali; 1995. Pancheri P, Sirigatti S: MMPI-2 (Adattamento Italiano). Firenze: Organizzazioni Speciali; 1995.
35.
Zurück zum Zitat American Psychiatric Association: Diagnostic and statistical manual of mental disorders. 4th edition. DC: Washington; 2000. American Psychiatric Association: Diagnostic and statistical manual of mental disorders. 4th edition. DC: Washington; 2000.
36.
Zurück zum Zitat World Health Organization: International statistical classification of disease and related health problems, Tenth Revision (ICD-10). Geneva: World Health Organization; 1992. World Health Organization: International statistical classification of disease and related health problems, Tenth Revision (ICD-10). Geneva: World Health Organization; 1992.
37.
Zurück zum Zitat Fasmer OB, Oedegaard KJ: Clinical characteristics of patients with major affective disorders and comorbid migraine. World J Biol Psychiatry 2011, 2: 149–155.CrossRef Fasmer OB, Oedegaard KJ: Clinical characteristics of patients with major affective disorders and comorbid migraine. World J Biol Psychiatry 2011, 2: 149–155.CrossRef
38.
Zurück zum Zitat Kalayadjian A, Merikangas K: Physical and mental comorbidity of headache in a nationally representative sample of US adults. Psychosom Med 2008, 70: 773–780. 10.1097/PSY.0b013e31817f9e80CrossRef Kalayadjian A, Merikangas K: Physical and mental comorbidity of headache in a nationally representative sample of US adults. Psychosom Med 2008, 70: 773–780. 10.1097/PSY.0b013e31817f9e80CrossRef
39.
Zurück zum Zitat Beghi E, Bussone G, D’Amico D, Cortelli P, Cevoli S, Manzoni GC, Torelli P, Tonini MC, Allais G, De Simone R, D’Onofrio F, Genco S, Moschiano F, Beghi M, Salvi S: Headache, anxiety and depressive disorder: the HADAS study. J Headache Pain 2010, 11: 141–150. 10.1007/s10194-010-0187-2PubMedCentralPubMedCrossRef Beghi E, Bussone G, D’Amico D, Cortelli P, Cevoli S, Manzoni GC, Torelli P, Tonini MC, Allais G, De Simone R, D’Onofrio F, Genco S, Moschiano F, Beghi M, Salvi S: Headache, anxiety and depressive disorder: the HADAS study. J Headache Pain 2010, 11: 141–150. 10.1007/s10194-010-0187-2PubMedCentralPubMedCrossRef
40.
Zurück zum Zitat Atasoy HT, Atasoy N, Unal AE, Emre U, Sumer M: Psychiatric comorbidity in medication overuse headache patients with pre-existing headache type of episodic tension-type headache. Eur J Pain 2005,9(3):285–91. 10.1016/j.ejpain.2004.07.006PubMedCrossRef Atasoy HT, Atasoy N, Unal AE, Emre U, Sumer M: Psychiatric comorbidity in medication overuse headache patients with pre-existing headache type of episodic tension-type headache. Eur J Pain 2005,9(3):285–91. 10.1016/j.ejpain.2004.07.006PubMedCrossRef
41.
Zurück zum Zitat Lake AE 3rd, Rains JC, Penzien DB, Lipchik GL: Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance. Headache 2005,45(5):493–506. 10.1111/j.1526-4610.2005.05101.xPubMedCrossRef Lake AE 3rd, Rains JC, Penzien DB, Lipchik GL: Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance. Headache 2005,45(5):493–506. 10.1111/j.1526-4610.2005.05101.xPubMedCrossRef
42.
Zurück zum Zitat Sheehan DV, Lecrubier Y, Sheehan KH, Janavs J, Weiller E, Keskiner A, Schinka J, Knapp E, Sheehan MF, Dunbar GC: The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry 1997,12(5):232–241. 10.1016/S0924-9338(97)83297-XCrossRef Sheehan DV, Lecrubier Y, Sheehan KH, Janavs J, Weiller E, Keskiner A, Schinka J, Knapp E, Sheehan MF, Dunbar GC: The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry 1997,12(5):232–241. 10.1016/S0924-9338(97)83297-XCrossRef
43.
Zurück zum Zitat Mongini F, Ibertis F, Barbalonga E, Raviola F: MMPI-2 profiles in chronic daily headache and their relationship to anxiety levels and accompanying symptoms. Headache 2000, 40: 466–472. 10.1046/j.1526-4610.2000.00070.xPubMedCrossRef Mongini F, Ibertis F, Barbalonga E, Raviola F: MMPI-2 profiles in chronic daily headache and their relationship to anxiety levels and accompanying symptoms. Headache 2000, 40: 466–472. 10.1046/j.1526-4610.2000.00070.xPubMedCrossRef
Metadaten
Titel
Personality traits in chronic daily headache patients with and without psychiatric comorbidity: an observational study in a tertiary care headache center
verfasst von
Marialuisa Rausa
Sabina Cevoli
Elisa Sancisi
Daniela Grimaldi
Gabriella Pollutri
Michela Casoria
Daniela Grieco
Alberto Bisi
Pietro Cortelli
Euro Pozzi
Giulia Pierangeli
Publikationsdatum
01.12.2013
Verlag
Springer Milan
Erschienen in
The Journal of Headache and Pain / Ausgabe 1/2013
Print ISSN: 1129-2369
Elektronische ISSN: 1129-2377
DOI
https://doi.org/10.1186/1129-2377-14-22

Weitere Artikel der Ausgabe 1/2013

The Journal of Headache and Pain 1/2013 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.