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Pain Research and Management
Volume 2019, Article ID 1874078, 9 pages
Research Article

Personality and Personality Disorders in Medication-Overuse Headache: A Controlled Study by SWAP-200

1ASST SS. Paolo and Carlo, S. Paolo Hospital, Milan, Italy
2Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
3Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
4Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
5Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
6Therapeutic Community “Villa Renata”, Venice, Italy
7Center for Individual and Couple Therapy, Genoa, Italy

Correspondence should be addressed to Annalisa Tanzilli; ti.1amorinu@illiznat.asilanna

Received 1 February 2019; Accepted 4 April 2019; Published 12 June 2019

Guest Editor: Athina Vadalouka

Copyright © 2019 Federica Galli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Medication-overuse headache (MOH) is a type of chronic headache, whose mechanisms are still unknown. The impact of psychological factors has been matter of debate from different perspectives. The role of personality and personality pathology in processes involved in MOH development has been advanced but was poorly studied. The hypothesis of addiction-like behaviors sustaining the drug misuse has been examined and reached contrasting findings. Objectives. This study is aimed at detecting personality and its disorders (PDs) in MOH, with a specific attention to the addiction aspect. Methods. Eighty-eight MOH patients have been compared with two clinical populations including 99 patients with substance use disorder (SUD) and 91 with PDs using the Shedler-Westen Assessment Procedure-200 (SWAP-200), a clinician-report tool that assesses both normal and pathological personality. MANCOVAs were performed to evaluate personality differences among MOH, SUD, and PD groups, controlling for age and gender. Results. MOH patients were predominantly women and older. They showed lower traits of the SWAP-200’s cluster A and B disorders than SUD and PD patients, who presented more severe levels of personality impairment. No differences in the SWAP-200’s cluster C have been found, indicating common personality features in these populations. At levels of specific PDs, MOH patients showed higher obsessive and dysphoric traits and better overall psychological functioning than SUD and PD patients. Conclusion. Although MOH, SUD, and PD populations have been evaluated in multiple sites with different levels of expertise, the study supported the presence of a specific constellation of personality in MOH patients including obsessive (perfectionist) and dysphoric characteristics, as well as good enough psychological resources. No similarities to drug-addicted and personality-disordered patients were found. Practitioners’ careful understanding of the personality characteristics of MOH patients may be useful to provide a road map for the implementation of more effective treatment strategies and intervention programs.